Provider Demographics
NPI:1083173983
Name:PLYMELL, TRAVIS (PTA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:PLYMELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 BALES AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-2887
Mailing Address - Country:US
Mailing Address - Phone:660-373-1325
Mailing Address - Fax:
Practice Address - Street 1:1200 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1036
Practice Address - Country:US
Practice Address - Phone:816-781-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017025085225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant