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Individual

TRAVIS JOHN POULSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LAT, ATC, CSCS

Contact information

Practice address
1910 UNIVERSITY DR, BOISE, ID 83725-0002
(262) 949-4026
Mailing address
N300 TOWER RD, EAGLE, WI 53119-1914
(262) 949-4026

Taxonomy

Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
AT-713
ID

Other

Enumeration date
03/27/2021
Last updated
03/27/2021
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