Provider Demographics
NPI:1770911893
Name:ALLIGOOD, TRAVIS (LMBT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:ALLIGOOD
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OLD CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-1328
Mailing Address - Country:US
Mailing Address - Phone:704-213-6059
Mailing Address - Fax:
Practice Address - Street 1:2125 OLD CONCORD RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-1328
Practice Address - Country:US
Practice Address - Phone:704-213-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist