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1609453380
TRAVIS JOHN POULSON
BOISE, ID
NPI
1609453380
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2081S0010X Physical Medicine & Rehabilitation, Sports Medicine
(Licence: ID AT-713)
Enumeration Date
2021-03-27
Last Update Date
2021-03-27
Business Address
TRAVIS JOHN POULSON LAT, ATC, CSCS
1910 UNIVERSITY DR
BOISE, ID 83725-0002
Phone number: 262-949-4026
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Mailing Address
TRAVIS JOHN POULSON LAT, ATC, CSCS
N300 TOWER RD
EAGLE, WI 53119-1914
Phone number: 262-949-4026
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