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Contact Information

TRAVIS J POULSON, LAT, ATC, CSCS
1910 UNIVERSITY DR
BOISE, ID83725-0002
 Phone: 262-949-4026
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

2081S0010X 25 Physician/Physical Medicine and Rehabilitation
Indicates primary specialty

NPI Profile & details for TRAVIS J POULSON · (Male)

NPI Number 1609453380
Status Active
Credentials LAT, ATC, CSCS
Entity Individual
Enumeration date 03/27/2021
Last updated 03/27/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • ID License # AT-713
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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