Provider Demographics
NPI:1265660971
Name:WARMOUTH, TRAVIS DONALD (MS, ATC,LAT)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:DONALD
Last Name:WARMOUTH
Suffix:
Gender:M
Credentials:MS, ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 PINCREST DR.
Mailing Address - Street 2:CONDO 7#
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-881-9609
Mailing Address - Fax:
Practice Address - Street 1:86 PINECREST DR
Practice Address - Street 2:CONDO 7E
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-4413
Practice Address - Country:US
Practice Address - Phone:802-881-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00001712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer