Travis Depew, PT, DPT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

61102342 Issued in WA

Practice address

4455 148TH Ave NE
Bellevue, WA 98007-3120

Phone

(425) 861-6255

NPI assigned

Aug 12, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Professional Recreation Organization, Inc.

  • Family Medicine Physician
  • Bellevue, WA
  • NPI 1861918518
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1023533874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 148TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073120",
            "telephone_number": "425-861-6255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 148TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073120",
            "telephone_number": "425-861-6255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6221 Metropolitan St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Carlsbad",
            "state": "CA",
            "postal_code": "920093096",
            "country_code": "US",
            "telephone_number": "760-707-5080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEPEW",
        "first_name": "TRAVIS",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-12",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "293414",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WA",
            "license": "61102342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dentistry of Bellevue
• Paul Denton, MD
• Manjusha V Deo
• Jessica L Depaepe, MD
• Kanyakanit Buppawong Depaz, LMP
• Kam Derakshani, DDS
• Julie Deramo, LMP
• Tatjana Deretic, M.D.
• Dermatology Arts, PLLC
• Dermatopatholoty Northwest PLLC

• Physical Medicine & Rehabilitation Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Physical Medicine & Rehabilitation Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.