Healthcare Provider Details

I. General information

NPI: 1952241663
Provider Name (Legal Business Name): TRAVIS L FOWLER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 SE MCLOUGHLIN BLVD STE 205
MILWAUKIE OR
97222-7428
US

IV. Provider business mailing address

3291 SE SILVER SPRINGS RD
MILWAUKIE OR
97222-7047
US

V. Phone/Fax

Practice location:
  • Phone: 503-330-6076
  • Fax:
Mailing address:
  • Phone: 503-330-6076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-15095
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: