Provider Demographics
NPI:1922242544
Name:LALOLI, TRAVIS (ATC-R)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:LALOLI
Suffix:
Gender:M
Credentials:ATC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16956 SW MEINECKE RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9061
Mailing Address - Country:US
Mailing Address - Phone:503-825-5566
Mailing Address - Fax:503-825-5501
Practice Address - Street 1:16956 SW MEINECKE RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9061
Practice Address - Country:US
Practice Address - Phone:503-825-5566
Practice Address - Fax:503-825-5501
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101192352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer