Provider Demographics
NPI:1083980965
Name:CLELAND, TRAVIS LEE (DO)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:CLELAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 EMBASSY PKWY
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-8320
Mailing Address - Country:US
Mailing Address - Phone:330-668-4040
Mailing Address - Fax:
Practice Address - Street 1:3975 EMBASSY PKWY STE 2
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8323
Practice Address - Country:US
Practice Address - Phone:330-668-4094
Practice Address - Fax:330-668-2971
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012032208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program