IndividualActive
Travis Poulson, LAT, ATC, CSCS
NPI 1609453380 · Sports Medicine (Physical Medicine & Rehabilitation) Physician · Boise, ID
Provider details
- NPI number
- 1609453380
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) PhysicianAllopathic & Osteopathic Physicians
- Credential
- LAT, ATC, CSCS
- Sex
- Male
- Sole proprietor
- No
- License
- AT-713 (ID)
Mailing address
N300 Tower Rd
Eagle, WI 53119-1914
Registry dates
- Enumerated
- 2021-03-27
- Last updated
- 2021-03-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.