Provider Demographics
NPI:1760919500
Name:TRAVIS, MONICA (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 CARMEL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-1560
Mailing Address - Country:US
Mailing Address - Phone:713-817-1731
Mailing Address - Fax:
Practice Address - Street 1:917 KIRBY RD
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-4400
Practice Address - Country:US
Practice Address - Phone:832-472-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952723967OtherBLUE CROSS BLUE SHIELD, AETNA, CIGNA
TX1952723967Medicare PIN