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NPI Code Detail

MEDICARE: TRAVIS DOOM PT, DPT

MEDICARE: TRAVIS DOOM PT, 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
1208100000XPhysical Medicine & Rehabilitation Physician5501018298MI
2225100000XPhysical Therapist1370802TX

General Provider Information

NPI Number : 1346746195
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS DOOM PT, DPT
Provider Business Mailing Address
First Line : 2816 E BELTLINE LN NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-9432
Country : US
Telephone Number : 616-361-8662
Fax Number :
Provider Business Practice Location Address
First Line : 413 W BETHEL RD STE 400
Second Line :
City : COPPELL
State : TX
Zip : 75019-4477
Country : US
Telephone Number : 972-304-9100
Fax Number : 972-304-9048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2018
Last Update Date : 11/29/2022

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Directions to “ TRAVIS DOOM PT, DPT” Practice Location

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