Provider Demographics
NPI:1073954319
Name:TRAVIS, DANIELLE DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:DAWN
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28726-2712
Mailing Address - Country:US
Mailing Address - Phone:828-606-8649
Mailing Address - Fax:
Practice Address - Street 1:600 CAROLINA VILLAGE RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2892
Practice Address - Country:US
Practice Address - Phone:828-692-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5042225200000X
SC2953225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant