Healthcare Provider Details

I. General information

NPI: 1073425955
Provider Name (Legal Business Name): TRAVIS SNODGRASS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 231
CABIN CREEK WV
25035-0231
US

IV. Provider business mailing address

PO BOX 231
CABIN CREEK WV
25035-0231
US

V. Phone/Fax

Practice location:
  • Phone: 681-317-3805
  • Fax:
Mailing address:
  • Phone: 681-317-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2025-4196
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: