Provider Demographics
NPI:1801805171
Name:TRAVERS, RICHARD SCOTT (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SCOTT
Last Name:TRAVERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COLONY POINT CIR APT 404
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2907
Mailing Address - Country:US
Mailing Address - Phone:706-331-8707
Mailing Address - Fax:
Practice Address - Street 1:1001 COLONY POINT CIR APT 404
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2907
Practice Address - Country:US
Practice Address - Phone:706-331-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist