Provider Demographics
NPI:1295845816
Name:NEFF, TRAVIS
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:NEFF
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 1:2105 KARA CT
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1392
Mailing Address - Country:US
Mailing Address - Phone:816-377-5141
Mailing Address - Fax:
Practice Address - Street 1:2105 KARA CT
Practice Address - Street 2:SUITE A-1
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1392
Practice Address - Country:US
Practice Address - Phone:816-377-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-11-03
Deactivation Date:2017-10-16
Deactivation Code:
Reactivation Date:2018-11-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2003028762OtherLICENSE#
MOMA1102001OtherMEDICARE PTAN