Provider Demographics
NPI:1770831141
Name:WOMER, TRAVIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:WOMER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2809
Mailing Address - Country:US
Mailing Address - Phone:607-654-2433
Mailing Address - Fax:
Practice Address - Street 1:205 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2809
Practice Address - Country:US
Practice Address - Phone:607-654-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033972-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist