Individual
TRAVIS W KLEINENDORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004047
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265623128
—
IA
01
—
70255
WELLMARK BLUE SHIELD
IA
Enumeration date
08/06/2007
Last updated
01/09/2020
Update your record
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