Basic Information
| Provider Information | |||||||||
| NPI: | 1083801492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRIVINO | ||||||||
| FirstName: | GEOFFREY | ||||||||
| MiddleName: | DENNIS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 REVERE BEACH PKWY APT 412 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021555162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813910321 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 PARKMAN ST | ||||||||
| Address2: | WACC 134 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021143117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177240125 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2007 | ||||||||
| LastUpdateDate: | 09/29/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 17909 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.