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NPI Code Detail

MEDICARE: MR. TRAVIS WAYNE VANDER REYDEN P.T.

MEDICARE: MR. TRAVIS WAYNE VANDER REYDEN P.T.
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
1225100000XPhysical Therapist05007152AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134104292
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TRAVIS WAYNE VANDER REYDEN P.T.
Provider Business Mailing Address
First Line : 3600 W BETHEL AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47304-5407
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 60160 BODNAR BLVD
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-9338
Country : US
Telephone Number : 574-247-9441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 04/09/2026

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