Provider Demographics
NPI:1588478424
Name:SMARDO, TRAVIS SR (CPED)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:SMARDO
Suffix:SR
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6505
Mailing Address - Country:US
Mailing Address - Phone:620-231-5940
Mailing Address - Fax:620-231-5948
Practice Address - Street 1:407 E CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6505
Practice Address - Country:US
Practice Address - Phone:620-231-5940
Practice Address - Fax:620-231-5948
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSCPED4827224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist