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General NPI Number Information
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NPI Number | 1265660971
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Entity Type | Individual
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Provider Name | TRAVIS DONALD WARMOUTH MS, ATC,LAT
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Gender | Male
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 86 PINECREST DR CONDO 7E
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-4413
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Country | US
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Telephone | 802-881-9609
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Fax |
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Provider Business Mailing Address
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Address Line | 86 PINCREST DR. CONDO 7#
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452
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Country | US
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Telephone | 802-881-9609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 104-0000171
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License Number State | VT
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