Provider Demographics
NPI:1194706119
Name:TRAVAGLIANTE, MICHAEL JOSEPH (ATC, LPTA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:TRAVAGLIANTE
Suffix:
Gender:M
Credentials:ATC, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 SUNVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1344
Mailing Address - Country:US
Mailing Address - Phone:440-442-7841
Mailing Address - Fax:216-595-2879
Practice Address - Street 1:4480 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5777
Practice Address - Country:US
Practice Address - Phone:216-595-2880
Practice Address - Fax:216-595-2879
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA02598225200000X
OHAT0001672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer