Provider Demographics
NPI:1225267115
Name:MAGDEN, TRAVIS J (PT)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:J
Last Name:MAGDEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2280 TRAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3020
Mailing Address - Country:US
Mailing Address - Phone:915-493-6794
Mailing Address - Fax:915-595-3922
Practice Address - Street 1:836 E REDD RD
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7221
Practice Address - Country:US
Practice Address - Phone:915-845-4060
Practice Address - Fax:915-845-4065
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189412225100000X
NM4009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219332801Medicaid
TX8L16638Medicare PIN