Provider Demographics
NPI:1962025700
Name:BURDICK, TRAVIS ALLEN (DPT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ALLEN
Last Name:BURDICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 GAUTIER VANCLEAVE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5105
Mailing Address - Country:US
Mailing Address - Phone:251-281-8346
Mailing Address - Fax:
Practice Address - Street 1:3880 GAUTIER VANCLEAVE RD STE 4
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5105
Practice Address - Country:US
Practice Address - Phone:251-281-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT-6874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist