Provider Demographics
NPI:1861949588
Name:DILLS, TRAVIS (PTA)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:DILLS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 KENILWOOD WAY APT 15
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4873
Mailing Address - Country:US
Mailing Address - Phone:606-271-8481
Mailing Address - Fax:
Practice Address - Street 1:460 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:KY
Practice Address - Zip Code:42170-9738
Practice Address - Country:US
Practice Address - Phone:270-529-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03477225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant