Individual
TRAVIS JACK LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1939 SW TROON AVE, BEND, OR 97702-3143
(503) 468-8592
(888) 394-2351
Mailing address
5020 SE 30TH AVE APT 97, PORTLAND, OR 97202-4551
(360) 540-7700
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09474
OR
Other
Enumeration date
08/30/2017
Last updated
08/30/2017
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