Provider Demographics
NPI:1992148456
Name:HEMINGWAY, TRAVIS (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:HEMINGWAY
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 NW 154TH ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2743
Mailing Address - Country:US
Mailing Address - Phone:786-262-4867
Mailing Address - Fax:
Practice Address - Street 1:2380 NW 154TH ST
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2743
Practice Address - Country:US
Practice Address - Phone:786-262-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist