Healthcare Provider Details

I. General information

NPI: 1578429809
Provider Name (Legal Business Name): TRAVIS SHEPHERD LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 MEADOWGREEN RD
RICHMOND VA
23294-5604
US

IV. Provider business mailing address

9309 MEADOWGREEN RD
RICHMOND VA
23294-5604
US

V. Phone/Fax

Practice location:
  • Phone: 757-202-1081
  • Fax:
Mailing address:
  • Phone: 757-202-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306603516
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: