Provider Demographics
NPI:1073917183
Name:BELNAP, TRAVIS H (HAD)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:H
Last Name:BELNAP
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14537 W GRAND AVE
Mailing Address - Street 2:#120
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8649
Mailing Address - Country:US
Mailing Address - Phone:623-362-2800
Mailing Address - Fax:623-362-8010
Practice Address - Street 1:14537 W GRAND AVE
Practice Address - Street 2:#120
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8649
Practice Address - Country:US
Practice Address - Phone:623-362-2800
Practice Address - Fax:623-362-8010
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD5385237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist