Provider Demographics
NPI:1215640313
Name:ANSTEE, TRAVIS MARTIN (DPT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:MARTIN
Last Name:ANSTEE
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 1:34 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-9362
Mailing Address - Country:US
Mailing Address - Phone:315-945-1834
Mailing Address - Fax:
Practice Address - Street 1:100 E MILLER ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1525
Practice Address - Country:US
Practice Address - Phone:315-331-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049382-012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics