Provider Demographics
NPI:1215694898
Name:HOLMES, TRAVIS (LMT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:HOLMES
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 1:418 MAIN ST STE 800
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1774
Mailing Address - Country:US
Mailing Address - Phone:570-225-9686
Mailing Address - Fax:
Practice Address - Street 1:418 MAIN ST STE 800
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1774
Practice Address - Country:US
Practice Address - Phone:570-225-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist