Provider Demographics
NPI:1225027857
Name:SCHELLING, TRAVIS K (PA-C)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:K
Last Name:SCHELLING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S 500 E
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2015
Mailing Address - Country:US
Mailing Address - Phone:801-320-5660
Mailing Address - Fax:801-320-5665
Practice Address - Street 1:230 S 500 E
Practice Address - Street 2:SUITE 510
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2015
Practice Address - Country:US
Practice Address - Phone:801-320-5660
Practice Address - Fax:801-320-5665
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3684131206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS74884Medicare UPIN