MEDICARE: TRAVIS RAULERSON MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA61251	FL

General Provider Information

NPI Number	:	1760203210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS RAULERSON MA

Provider Business Mailing Address
First Line	:	10870 US HIGHWAY 1 N UNIT 105
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32081-7804
Country	:	US
Telephone Number	:	904-686-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	10870 US HIGHWAY 1 N UNIT 105
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-7804
Country	:	US
Telephone Number	:	904-686-6060
Fax Number	:	904-686-8080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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