Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CH9784 | FL |
NPI | 1275765463 |
---|---|
Provider Name | Dr. Travis Robert Mohr |
First Address | Tampa, FL 33647-3467 |
Second Address | Tampa, FL 33647-3467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 27/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001894300 | (05) | FL |