MEDICARE: MR. TRAVIS FETCHKO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT022025	OH
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1043755283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRAVIS FETCHKO

Provider Business Mailing Address
First Line	:	4349 TALMADGE RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3527
Country	:	US
Telephone Number	:	419-654-8818
Fax Number	:

Provider Business Practice Location Address
First Line	:	4349 TALMADGE RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3527
Country	:	US
Telephone Number	:	419-654-8818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2016
Last Update Date	:	10/18/2025

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