Active NPI
Scott Trevino, PTA
- Physical Therapy Assistant
- Goshen, IN
National Provider Identifier
1336382209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06003409A
- Practice address
- 1332 Waterford Xing Cir
Goshen, IN 46526-6009 - Phone
- (574) 534-3920
- Fax
- (574) 533-1968
- NPI assigned
- Apr 8, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 06003409A | IN | Primary |
Addresses
Primary practice location
1332 Waterford Xing Cir
Goshen, IN 46526-6009
Mailing address
1650 Lyndon Farm CT
Suitem201
Louisville, KY 40223-5002
Phone (502) 412-5847
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06003409A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240185600000",
"number": "1336382209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 LYNDON FARM CT",
"address_2": "SUITEM201",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402235002",
"telephone_number": "502-412-5847",
"fax_number": "502-412-0407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1332 WATERFORD XING CIR",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465266009",
"telephone_number": "574-534-3920",
"fax_number": "574-533-1968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TREVINO",
"first_name": "SCOTT",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-08",
"last_updated": "2009-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06003409A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.