Individual
TRAVIS REID EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1455 NE COLORADO ST, PULLMAN, WA 99163
(509) 335-0238
Mailing address
PO BOX 641602, PULLMAN, WA 99164-1602
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A160584184
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200014856
BOARD OF CERTIFICATION
CA
01
—
63370
NATIONAL ATHLETIC TRAINERS' ASSOCIATION
CA
01
—
A160584184
WASHINGTON STATE DEPARTMENT OF HEALTH, LICENSED ATHLETIC TRAINER
WA
Enumeration date
05/03/2017
Last updated
05/03/2017
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