Provider Demographics
NPI:1619130374
Name:FRIBERG, TRAVIS KENT (PT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:KENT
Last Name:FRIBERG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 LOMA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-9506
Mailing Address - Country:US
Mailing Address - Phone:661-889-3754
Mailing Address - Fax:
Practice Address - Street 1:2224 5TH AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5816
Practice Address - Country:US
Practice Address - Phone:530-534-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist