Provider Demographics
NPI:1457750549
Name:EVERMAN, JOHN TRAVIS (LMT, MM P)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TRAVIS
Last Name:EVERMAN
Suffix:
Gender:M
Credentials:LMT, MM P
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:TRAVIS
Other - Last Name:EVERMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT MMP
Mailing Address - Street 1:16015 GINO PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247
Mailing Address - Country:US
Mailing Address - Phone:210-589-4465
Mailing Address - Fax:
Practice Address - Street 1:16015 GINO PARK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247
Practice Address - Country:US
Practice Address - Phone:210-589-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT113402225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist