Healthcare Provider Details

I. General information

NPI: 1003888926
Provider Name (Legal Business Name): TRAVIS LEE ARMSTRONG MS, ACT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9612 N 84TH DR
PEORIA AZ
85345-7140
US

IV. Provider business mailing address

9612 N 84TH DR
PEORIA AZ
85345-7140
US

V. Phone/Fax

Practice location:
  • Phone: 602-639-6925
  • Fax: 602-343-4827
Mailing address:
  • Phone: 602-639-6925
  • Fax: 602-343-4827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: