Healthcare Provider Details

I. General information

NPI: 1609791649
Provider Name (Legal Business Name): IAN TRAVIS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 INVERNESS DR W
ENGLEWOOD CO
80112-5065
US

IV. Provider business mailing address

175 INVERNESS DR W STE 100
ENGLEWOOD CO
80112-5066
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3333
  • Fax:
Mailing address:
  • Phone: 303-694-3333
  • Fax: 303-694-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0021457
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL26642
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: