Provider Demographics
NPI:1851974844
Name:WHITEFIELD, TRAVIS DANIEL
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:DANIEL
Last Name:WHITEFIELD
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 1:1412 SIDNEY BAKER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-2725
Mailing Address - Country:US
Mailing Address - Phone:830-315-8420
Mailing Address - Fax:
Practice Address - Street 1:1412 SIDNEY BAKER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2725
Practice Address - Country:US
Practice Address - Phone:830-315-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty