Provider Demographics
NPI:1619615275
Name:TRAVER, ANDREW CHRISTIAN (DPT, MBA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHRISTIAN
Last Name:TRAVER
Suffix:
Gender:M
Credentials:DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 SONOMA ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-8690
Mailing Address - Country:US
Mailing Address - Phone:415-717-3459
Mailing Address - Fax:
Practice Address - Street 1:420 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2503
Practice Address - Country:US
Practice Address - Phone:406-777-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty