Provider Demographics
NPI:1669295549
Name:TRAVIS, DUANE LEE
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:LEE
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CANTLEY ST
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:MI
Mailing Address - Zip Code:48367-6602
Mailing Address - Country:US
Mailing Address - Phone:248-798-9386
Mailing Address - Fax:
Practice Address - Street 1:360 CANTLEY ST
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:MI
Practice Address - Zip Code:48367-6602
Practice Address - Country:US
Practice Address - Phone:248-798-9386
Practice Address - Fax:248-605-0300
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist