Provider Demographics
NPI:1871009464
Name:TWILBECK, TRAVIS JAMES (MS, EP-C)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JAMES
Last Name:TWILBECK
Suffix:
Gender:M
Credentials:MS, EP-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 BENT OAK CV
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4185
Mailing Address - Country:US
Mailing Address - Phone:731-336-6083
Mailing Address - Fax:
Practice Address - Street 1:2550 FLOWOOD DR STE 403
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9322
Practice Address - Country:US
Practice Address - Phone:601-936-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist