Provider Demographics
NPI:1780229161
Name:PETER FAUST, TRAVA (CMT)
Entity Type:Individual
Prefix:
First Name:TRAVA
Middle Name:
Last Name:PETER FAUST
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 BEACH PARK BLVD APT 111
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1966
Mailing Address - Country:US
Mailing Address - Phone:707-228-9736
Mailing Address - Fax:
Practice Address - Street 1:838 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1902
Practice Address - Country:US
Practice Address - Phone:707-228-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist