Provider Demographics
NPI:1164270104
Name:PRITCHARD, TRAVIS HOWARD (LMBT, LRTA)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:HOWARD
Last Name:PRITCHARD
Suffix:
Gender:M
Credentials:LMBT, LRTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MIMOSA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5257
Mailing Address - Country:US
Mailing Address - Phone:704-880-5912
Mailing Address - Fax:
Practice Address - Street 1:104 MIMOSA HILLS DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5257
Practice Address - Country:US
Practice Address - Phone:704-880-5912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21866225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist