Healthcare Provider Details

I. General information

NPI: 1295110880
Provider Name (Legal Business Name): TRAVIS JAMES HOVEL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 VIOLET ST STE 150
GOLDEN CO
80401-6724
US

IV. Provider business mailing address

251 VIOLET ST STE 150
GOLDEN CO
80401-6724
US

V. Phone/Fax

Practice location:
  • Phone: 303-279-6000
  • Fax:
Mailing address:
  • Phone: 303-279-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0013659
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: