Individual
TRAVIS J NICHOLS
Active
Individual
TRAVIS J NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1103824
KS
2251X0800X
Orthopedic Physical Therapist
0012597
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104037751
BCBS KS
KS
05
—
201182370A
—
KS
01
—
44204046
BCBS KC
—
01
—
KA2868020
MEDICARE PTAN
KS
Enumeration date
06/29/2010
Last updated
09/29/2020
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