Provider Demographics
NPI:1497517700
Name:BREEDING, TRAVIS (PT, MPT, NCS)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:BREEDING
Suffix:
Gender:M
Credentials:PT, MPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6763 COUNTY ROAD 19
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-9140
Mailing Address - Country:US
Mailing Address - Phone:530-624-9056
Mailing Address - Fax:
Practice Address - Street 1:6763 COUNTY ROAD 19
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-9140
Practice Address - Country:US
Practice Address - Phone:530-624-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist