Provider Demographics
NPI:1154401305
Name:LOMBARDI, TRAVIS B (MPT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:B
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4273
Mailing Address - Country:US
Mailing Address - Phone:860-326-5454
Mailing Address - Fax:860-326-5502
Practice Address - Street 1:772 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4273
Practice Address - Country:US
Practice Address - Phone:860-326-5454
Practice Address - Fax:860-326-5502
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT56080005712CT1OtherANTHEM BCBS PROVIDER NUM
CT7903503OtherAETNA PROVIDER NUMBER
CT56080005712CT1OtherANTHEM BCBS PROVIDER NUM