MEDICARE: VICTORIA LYNNE TRAVIS PT, 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	004342	WV

General Provider Information

NPI Number	:	1952916470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA LYNNE TRAVIS PT, DPT

Provider Business Mailing Address
First Line	:	2382 W MAIN ST
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-7521
Country	:	US
Telephone Number	:	304-782-1052
Fax Number	:

Provider Business Practice Location Address
First Line	:	2382 W MAIN ST
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-7521
Country	:	US
Telephone Number	:	304-782-1052
Fax Number	:

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

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	09/11/2020

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