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General NPI Number Information
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NPI Number | 1972598191
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Entity Type | Individual
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Provider Name | JOHN TODD TRAVIS A.T.C., M.S., P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 2382 W MAIN ST
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City | SALEM
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State | WV
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Zip | 26426-7521
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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 | 2382 W MAIN ST
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City | SALEM
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State | WV
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Zip | 26426-7521
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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 |
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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 | 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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