Travis Clemmer, P.T.A.

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2082181 Issued in TX

Practice address

2525 N Grandview Ave
Ste 400
Odessa, TX 79761-1600

Phone

(432) 550-4700

Fax

(432) 550-4715

NPI assigned

Sep 13, 2011

Last updated

Sep 13, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315872000000",
    "number": "1205118601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 N GRANDVIEW AVE",
            "address_2": "STE 400",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797611600",
            "telephone_number": "432-550-4700",
            "fax_number": "432-550-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 N GRANDVIEW AVE",
            "address_2": "STE 400",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797611600",
            "telephone_number": "432-550-4700",
            "fax_number": "432-550-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMMER",
        "first_name": "TRAVIS",
        "credential": "P.T.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-13",
        "last_updated": "2011-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2082181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cibolo Park Healthcare LLC (Parks Assisted Living Center)
• City of Odessa (City of Odessa Ambulance Service)
• Clark Chiropractic Clinic
• Roger Dale Clark, HIS
• Virginia Gayle Clark, LPC
• Courtney Clubb, MSN-FNP
• Steve Wayne Cobb, DDS
• Dawn Cockrell LM CPM, L.M., C.P.M.
• Ralph Cockrell, OD
• Maria M Cole, FNP

• Physical Therapy Assistant in Odessa, TX
• Providers in Odessa, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; 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.