Provider Demographics
NPI:1568198042
Name:WILLMAN, TRAVIS LEE ((PRSS))
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:WILLMAN
Suffix:
Gender:M
Credentials:(PRSS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PRICHARD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3136
Mailing Address - Country:US
Mailing Address - Phone:304-235-0122
Mailing Address - Fax:
Practice Address - Street 1:201 PRICHARD ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3136
Practice Address - Country:US
Practice Address - Phone:304-235-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist