Individual
TRAVIS WAYNE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA, LMT
Contact information
Practice address
784 WALL ST STE 100P, O FALLON, IL 62269-2088
(618) 550-9570
Mailing address
415 S 5TH ST, CASEYVILLE, IL 62232-1456
(618) 550-9570
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160009325
IL
225700000X
Massage Therapist
227016850
IL
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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