MEDICARE: TRAVIS LAYNE ASHLEY DPT

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	1284510	TX

General Provider Information

NPI Number	:	1770026908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS LAYNE ASHLEY DPT

Provider Business Mailing Address
First Line	:	1613 BOB DR
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-9115
Country	:	US
Telephone Number	:	806-831-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 BOB DR
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-9115
Country	:	US
Telephone Number	:	806-831-2309
Fax Number	:

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

Provider Enumeration Date	:	11/20/2016
Last Update Date	:	11/20/2016

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