Provider Demographics
NPI:1811792765
Name:HYATT, TRAVIS GUSTAVE (MS, LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:GUSTAVE
Last Name:HYATT
Suffix:
Gender:M
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2942
Mailing Address - Country:US
Mailing Address - Phone:414-852-4910
Mailing Address - Fax:
Practice Address - Street 1:1245 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2507
Practice Address - Country:US
Practice Address - Phone:414-852-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2081392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer