Healthcare Provider Details

I. General information

NPI: 1760982672
Provider Name (Legal Business Name): TRAVIS JAMES HUTCHINSON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29650 BRADLEY RD
MENIFEE CA
92586-6521
US

IV. Provider business mailing address

515 SCARLET PL
SAN MARCOS CA
92069-3280
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-0455
  • Fax:
Mailing address:
  • Phone: 623-512-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT294361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: