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NPI Code Detail

MEDICARE: TRAVIS GERRALD PT

MEDICARE: TRAVIS GERRALD PT
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
1225100000XPhysical TherapistP19583NC

General Provider Information

NPI Number : 1174914188
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS GERRALD PT
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6324 FAIRVIEW RD STE 202
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3361
Country : US
Telephone Number : 980-302-9740
Fax Number : 980-302-9750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2015
Last Update Date : 06/11/2021

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Directions to “ TRAVIS GERRALD PT” Practice Location

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