Provider Demographics
NPI:1275927774
Name:ERWIN, TRAVIS (PTA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:ERWIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:TRAVIS
Other - Middle Name:BRANDON
Other - Last Name:ERWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:2221 DILLON RD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9454
Mailing Address - Country:US
Mailing Address - Phone:575-762-4495
Mailing Address - Fax:575-762-8051
Practice Address - Street 1:2221 DILLON RD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9454
Practice Address - Country:US
Practice Address - Phone:575-762-4495
Practice Address - Fax:575-762-8051
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0842225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant