Trevor M Provencher, DPT, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1406842 Issued in TX

Practice address

3456 State Highway 16 South
Bandera, TX 78003

Phone

(830) 796-3447

Fax

(830) 796-3685

NPI assigned

Apr 11, 2025

Last updated

May 29, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Momentum Physical and Sports Rehabilitation Limited PartnershipGroup PAC ID 0446575732, 51 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Momentum Physical & Sports Rehabilitation Limited Partnership

  • Physical Therapist
  • Helotes, TX
  • NPI 1871990275
  Medicare reassignment Care Compare group NPD
• Momentum Physical & Sports Rehabilitation Limited Partnership

  • Physical Therapist
  • Tampa, FL
  • NPI 1609243328
  NPD
• Comprehensive Physical Therapy

  • Physical Therapist
  • Bandera, TX
  • NPI 1215037411
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1992590822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12952 BANDERA RD STE 107",
            "city": "HELOTES",
            "state": "TX",
            "postal_code": "780234733",
            "telephone_number": "830-796-3447",
            "fax_number": "830-796-3685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3456 STATE HIGHWAY 16 SOUTH",
            "city": "BANDERA",
            "state": "TX",
            "postal_code": "78003",
            "telephone_number": "830-796-3447",
            "fax_number": "830-796-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "TREVOR",
        "middle_name": "M",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-11",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1406842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard K Newman, M.D.
• Erin Franco Otto, PT, DPT
• Kelly Renee Pacheco, FNP-BC
• Joy Perez, FNP-BC
• PHCC-Bandera Rehabilitation and Health Care Center, LLC (Bandera Adult Day Care Center)
• Leslie Citlalic Ramirez, LPC-A
• Anna Reid, MA, LPC
• Joshua Nathaniel Reyes, APRN, FNP-C
• Jody S. Robeson, PT
• Marcos Rubio

• Physical Therapist in Bandera, TX
• Providers in Bandera, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.