Individual
MRS. AMANDA ROSE TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
6105 WILSON AVE SW, WYOMING, MI 49418-9714
(616) 486-5055
Mailing address
6105 WILSON AVE SW, WYOMING, MI 49418-9714
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501012166
MI
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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