Provider Demographics
NPI:1467631333
Name:JAGER, TRAVIS (PT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:JAGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-8567
Mailing Address - Country:US
Mailing Address - Phone:269-203-7385
Mailing Address - Fax:
Practice Address - Street 1:8801 N 32ND ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-8567
Practice Address - Country:US
Practice Address - Phone:269-203-7385
Practice Address - Fax:269-216-7634
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236750Medicare PIN