Provider Demographics
NPI:1922465202
Name:STEWART, TRAVIS
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:STEWART
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 1:169 ELSING GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:23075-2451
Mailing Address - Country:US
Mailing Address - Phone:703-559-9306
Mailing Address - Fax:
Practice Address - Street 1:169 ELSING GREEN WAY
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-2451
Practice Address - Country:US
Practice Address - Phone:703-559-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA002-00594920343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)