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General NPI Number Information
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NPI Number | 1144699174
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Entity Type | Individual
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Provider Name | TRAVIS LEE ROUTH PT
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Gender | Male
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 600 W SALISBURY ST SUITE A
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City | ASHEBORO
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State | NC
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Zip | 27203-5590
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Country | US
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Telephone | 336-629-6397
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Fax | 336-629-6939
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Provider Business Mailing Address
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Address Line | 218 FOUST ST STE C
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City | ASHEBORO
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State | NC
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Zip | 27203-5476
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Country | US
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Telephone | 336-625-2333
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Fax | 336-625-5511
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P15813
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License Number State | NC
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