Provider Demographics
NPI:1780015750
Name:PARENT, TRAVIS AARON (MS, ATC, PES, CES)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:AARON
Last Name:PARENT
Suffix:
Gender:M
Credentials:MS, ATC, PES, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801
Mailing Address - Street 2:157 REACH ROAD, W-3
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769
Mailing Address - Country:US
Mailing Address - Phone:207-227-9739
Mailing Address - Fax:
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2844
Practice Address - Country:US
Practice Address - Phone:207-227-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT3342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer