Provider Demographics
NPI:1700407970
Name:DILLON, TRAVIS LEE (ATC/L)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:DILLON
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 N SENECA DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-9322
Mailing Address - Country:US
Mailing Address - Phone:956-460-5174
Mailing Address - Fax:
Practice Address - Street 1:3200 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1960
Practice Address - Country:US
Practice Address - Phone:956-460-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer