Healthcare Provider Details

I. General information

NPI: 1831053495
Provider Name (Legal Business Name): TRAVIS POWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 10TH AVE STE 9
SEATTLE WA
98122-3889
US

IV. Provider business mailing address

1423 10TH AVE STE 9
SEATTLE WA
98122-3889
US

V. Phone/Fax

Practice location:
  • Phone: 206-229-9822
  • Fax:
Mailing address:
  • Phone: 206-229-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number00009324
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: