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NPI Code Detail

MEDICARE: MR. KEITH TRAVERS PT, MTC

MEDICARE: MR. KEITH TRAVERS PT, MTC
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 Therapist070012713IL

General Provider Information

NPI Number : 1922177468
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH TRAVERS PT, MTC
Provider Business Mailing Address
First Line : 2555 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1768
Country : US
Telephone Number : 773-755-7566
Fax Number :
Provider Business Practice Location Address
First Line : 2555 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1768
Country : US
Telephone Number : 773-755-7566
Fax Number : 773-755-7580
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 11/06/2022

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