Provider Demographics
NPI:1407398605
Name:DAVIS, TRAVIS DALE (DPT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:DALE
Last Name:DAVIS
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 1:116 STAFFORDSHIRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625
Mailing Address - Country:US
Mailing Address - Phone:479-252-1989
Mailing Address - Fax:
Practice Address - Street 1:1515 W CENTER ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-3423
Practice Address - Country:US
Practice Address - Phone:479-252-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-06
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1276171225100000X
NCP17776225100000X
AR4129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist