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General NPI Number Information
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NPI Number | 1619130374
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Entity Type | Individual
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Provider Name | TRAVIS KENT FRIBERG PT
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Gender | Male
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 2224 5TH AVE
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City | OROVILLE
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State | CA
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Zip | 95965-5816
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Country | US
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Telephone | 530-534-5452
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Fax |
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Provider Business Mailing Address
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Address Line | 195 LOMA VISTA DR
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City | OROVILLE
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State | CA
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Zip | 95966-9506
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Country | US
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Telephone | 661-889-3754
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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 | 23667
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License Number State | CA
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