Provider Demographics
NPI:1104595636
Name:MANER, TRAVIS W (LMT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:W
Last Name:MANER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22129 N CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-9523
Mailing Address - Country:US
Mailing Address - Phone:206-409-3535
Mailing Address - Fax:
Practice Address - Street 1:17416 SR 9 STE B
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-6304
Practice Address - Country:US
Practice Address - Phone:360-668-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61201504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist