Provider Demographics
NPI:1558065938
Name:JONES, TRAVIS (LMT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:JONES
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 1:1050 LARRABEE AVE SUITE 104
Mailing Address - Street 2:PMB 401
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:808-936-5490
Mailing Address - Fax:
Practice Address - Street 1:777 MULLIS ST
Practice Address - Street 2:SUITE D
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-9822
Practice Address - Country:US
Practice Address - Phone:808-936-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61061990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty