Provider Demographics
NPI:1790786754
Name:TRAVIS, BETH D (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:D
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:D
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8276 PARK RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020
Mailing Address - Country:US
Mailing Address - Phone:585-343-9496
Mailing Address - Fax:585-343-9497
Practice Address - Street 1:8276 PARK RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020
Practice Address - Country:US
Practice Address - Phone:585-343-9496
Practice Address - Fax:585-343-9497
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009051-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
106283FTOtherPREFERRED CARE
000611314001OtherBLUE CROSS
00011193601OtherUNIVERA
9303902OtherINDEPENDENT HEALTH
9303902OtherINDEPENDENT HEALTH