Provider Demographics
NPI:1588054175
Name:DEABAY, TRAVIS (DPT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:DEABAY
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 1:62 GRAHAM AVE S
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5879
Mailing Address - Country:US
Mailing Address - Phone:072-496-6212
Mailing Address - Fax:888-714-1889
Practice Address - Street 1:336 MOUNT HOPE AVE STE 9
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4236
Practice Address - Country:US
Practice Address - Phone:207-249-6621
Practice Address - Fax:207-512-1254
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4040225100000X
RIPT02764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist