Provider Demographics
NPI:1710764840
Name:PASWATERS, TRAVIS WARNER FREDRICK
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:WARNER FREDRICK
Last Name:PASWATERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11438 COUNTY ROAD 19
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-9706
Mailing Address - Country:US
Mailing Address - Phone:720-400-2951
Mailing Address - Fax:
Practice Address - Street 1:11438 COUNTY ROAD 19
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-9706
Practice Address - Country:US
Practice Address - Phone:720-400-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COICNON150386171W00000X, 171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171W00000XOther Service ProvidersContractor