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1104465145
TRAVIS NORTHERN
COLUMBIA, MO
NPI
1104465145
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
208100000X Physical Medicine & Rehabilitation
(Licence: TX 1304720)
Enumeration Date
2019-12-21
Last Update Date
2019-12-21
Business Address
TRAVIS NORTHERN
800 HOSPITAL DR
COLUMBIA, MO 65201-5275
Phone number: 573-814-6000
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Mailing Address
TRAVIS NORTHERN
2997 OAK ST APT 205
KANSAS CITY, MO 64108-3370
Phone number: 417-342-7855
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