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General NPI Number Information
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NPI Number | 1659365724
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Entity Type | Organization
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Legal Business Name | TRAVIS PHYSICAL THERAPY & SPORTS MEDICINE INC
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | RR 1 BOX 75-3
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City | SALEM
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State | WV
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Zip | 26426-9604
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Country | US
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Telephone | 304-782-1052
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Fax | 304-782-1053
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Provider Business Mailing Address
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Address Line | RR 1 BOX 75-3
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City | SALEM
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State | WV
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Zip | 26426-9604
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Country | US
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Telephone | 304-782-1052
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Fax | 304-782-1053
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Authorized Official
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Title or Position | PRESIDENT PHYSICAL THERAPIST
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Name | JOHN TODD TRAVIS
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Credential | ATC MS PT
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Telephone | 304-782-1052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 987
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License Number State | WV
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