Provider Demographics
NPI:1033217419
Name:RIGBY, TRAVIS ROSS (AUD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:ROSS
Last Name:RIGBY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 N 2ND E STE 3
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1638
Mailing Address - Country:US
Mailing Address - Phone:208-356-0766
Mailing Address - Fax:208-359-9488
Practice Address - Street 1:30 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:ID
Practice Address - Zip Code:83445-2113
Practice Address - Country:US
Practice Address - Phone:208-624-0116
Practice Address - Fax:208-624-0181
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD1129231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807076900Medicaid