MEDICARE: TRAVIS J NICHOLS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	0012597	CO
2	225100000X	Physical Therapist	1103824	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	KA2868020	OTHER	KS	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1104037751	OTHER	KS	BCBS KS
3	44204046	OTHER		BCBS KC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104137751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS J NICHOLS DPT

Provider Business Mailing Address
First Line	:	426A MCCALL RD
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-5032
Country	:	US
Telephone Number	:	785-776-0670
Fax Number	:	785-776-0096

Provider Business Practice Location Address
First Line	:	4201B ANDERSON AVE
Second Line	:	SUITE 1
City	:	MANHATTAN
State	:	KS
Zip	:	66503-7601
Country	:	US
Telephone Number	:	785-539-5555
Fax Number	:	785-539-4551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	09/29/2020

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Directions to “ TRAVIS J NICHOLS DPT” Practice Location

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