Provider Demographics
NPI:1154408276
Name:NESTLERODE, TRAVIS PATRICK (DPT)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:PATRICK
Last Name:NESTLERODE
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 1:405 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4427
Mailing Address - Country:US
Mailing Address - Phone:704-692-0317
Mailing Address - Fax:252-966-0077
Practice Address - Street 1:405 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4427
Practice Address - Country:US
Practice Address - Phone:704-692-0317
Practice Address - Fax:252-966-0077
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist