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General NPI Number Information
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NPI Number | 1083137871
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Entity Type | Organization
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Legal Business Name | RURAL PODIATRY, LLC
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7010 MOUNTAIN RD
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City | HALIFAX
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State | VA
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Zip | 24558-2392
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Country | US
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Telephone | 434-250-4862
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Fax | 727-803-6980
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Provider Business Mailing Address
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Address Line | 7010 MOUNTAIN RD
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City | HALIFAX
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State | VA
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Zip | 24558-2392
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Country | US
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Telephone | 434-250-4862
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROGER PATRICK TRAVIS
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Credential | DPM
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Telephone | 434-250-4862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | VV14519855
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License Number State | VA
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