Provider Demographics
NPI:1073935870
Name:AMMONS, TRAVIS (PT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:AMMONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7368
Mailing Address - Country:US
Mailing Address - Phone:352-314-9300
Mailing Address - Fax:352-787-4977
Practice Address - Street 1:210 S LAKE ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-314-9300
Practice Address - Fax:352-787-4977
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist