Provider Demographics
NPI:1235308404
Name:DUFFEY, TRAVIS DUSTIN (LMT)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:DUSTIN
Last Name:DUFFEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 N BRICE RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6510
Mailing Address - Country:US
Mailing Address - Phone:614-367-7529
Mailing Address - Fax:614-367-7530
Practice Address - Street 1:99 N BRICE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6510
Practice Address - Country:US
Practice Address - Phone:614-367-7529
Practice Address - Fax:614-367-7530
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.015659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist