Healthcare Provider Details

I. General information

NPI: 1992277974
Provider Name (Legal Business Name): TRAVIS BYERS LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2019
Last Update Date: 01/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR STE 200
COLORADO SPRINGS CO
80920-7513
US

IV. Provider business mailing address

2238 STEPPING STONES WAY
COLORADO SPRINGS CO
80904-2750
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax:
Mailing address:
  • Phone: 719-426-1847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.0013828
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: