Provider Demographics
NPI:1477881944
Name:TRAVIS, RONNY
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 MOUNT BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-6376
Mailing Address - Country:US
Mailing Address - Phone:423-639-7689
Mailing Address - Fax:
Practice Address - Street 1:624 MOUNT BETHEL RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-6376
Practice Address - Country:US
Practice Address - Phone:423-639-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-22
Last Update Date:2009-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000005221227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified