Travis Wayne King, PTA, LMT

NPI #1023837085 in O Fallon, Illinois

Provider Information

NPI Number: 1023837085
Entity Type: Individual
Name: Travis Wayne King, PTA, LMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Credential: PTA, LMT
Enumeration Date: Oct 7, 2024
Last Updated: Oct 7, 2024

Practice Location

Address: 784 WALL ST STE 100P
City: O Fallon
State: Illinois
ZIP Code: 62269-2088
Phone: (618) 550-9570

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X
Physical Therapy Assistant	225200000X	Primary

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