Provider Demographics
NPI:1235650813
Name:TRAVIS, AHNA (DPT)
Entity Type:Individual
Prefix:
First Name:AHNA
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 BELLEVUE WAY NE APT 7
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3686
Mailing Address - Country:US
Mailing Address - Phone:907-980-9424
Mailing Address - Fax:
Practice Address - Street 1:900 NE 27TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9548
Practice Address - Country:US
Practice Address - Phone:541-382-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2017-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60626143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist