MEDICARE: MR. JOHN TODD TRAVIS A.T.C., M.S., P.T.

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	208100000X	Physical Medicine & Rehabilitation Physician	987	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	650010940	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972598191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN TODD TRAVIS A.T.C., M.S., P.T.

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	:	304-782-1053

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	:	304-782-1053

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/10/2013

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