Provider Demographics
NPI:1104137751
Name:NICHOLS, TRAVIS J (DPT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:J
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426A MCCALL RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5032
Mailing Address - Country:US
Mailing Address - Phone:785-776-0670
Mailing Address - Fax:785-776-0096
Practice Address - Street 1:4201B ANDERSON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7601
Practice Address - Country:US
Practice Address - Phone:785-539-5555
Practice Address - Fax:785-539-4551
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00125972251X0800X
KS1103824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2868020OtherMEDICARE PTAN
KS1104037751OtherBCBS KS
44204046OtherBCBS KC
KS201182370AMedicaid
MO44204036OtherBCBS KC