Provider Demographics
NPI:1528953148
Name:HALSETH, TRAVIS JOHN (ATC)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JOHN
Last Name:HALSETH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3598
Mailing Address - Country:US
Mailing Address - Phone:554-191-3857
Mailing Address - Fax:
Practice Address - Street 1:2727 LEO HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8835
Practice Address - Country:US
Practice Address - Phone:541-913-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101146342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer