Provider Demographics
NPI:1972956183
Name:BAILOUS, TRAVIA
Entity Type:Individual
Prefix:
First Name:TRAVIA
Middle Name:
Last Name:BAILOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 DOOLITTLE AVE APT 216
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2593
Mailing Address - Country:US
Mailing Address - Phone:702-587-8423
Mailing Address - Fax:
Practice Address - Street 1:900 DOOLITTLE AVE APT 216
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2593
Practice Address - Country:US
Practice Address - Phone:702-587-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner