Healthcare Provider Details

I. General information

NPI: 1699601278
Provider Name (Legal Business Name): MR. TRAVIS JOHN BURLESON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N SPENCE AVE
GOLDSBORO NC
27534-4263
US

IV. Provider business mailing address

605 N SPENCE AVE
GOLDSBORO NC
27534-4263
US

V. Phone/Fax

Practice location:
  • Phone: 919-751-0555
  • Fax: 919-751-3001
Mailing address:
  • Phone: 919-751-0555
  • Fax: 919-751-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23308
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: