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General NPI Number Information
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NPI Number | 1932948643
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Entity Type | Individual
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Provider Name | BRAD TRAVERSE
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Gender | Male
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 409 GRADY RD
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City | ETOWAH
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State | TN
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Zip | 37331-1903
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Country | US
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Telephone | 423-263-1138
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Fax |
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Provider Business Mailing Address
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Address Line | 11619 LANESBOROUGH WAY APT 706
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City | FARRAGUT
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State | TN
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Zip | 37934-7815
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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