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General NPI Number Information
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NPI Number | 1538651393
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Entity Type | Individual
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Provider Name | TRAVIS RYAN STAFFORD DPT
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Gender | Male
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 2668 E CITIZENS DR STE 5
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4796
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Country | US
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Telephone | 479-442-7473
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Fax | 479-239-5444
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Provider Business Mailing Address
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Address Line | 4443 W MOUNT COMFORT RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-5970
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Country | US
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Telephone |
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Fax |
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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 | PT5292
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License Number State | AR
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