Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP003850 | NC |
NPI | 1306496187 |
---|---|
Provider Name | Travis Barlow |
First Address | Charlotte, NC 28211-1359 |
Second Address | Charlotte, NC 28211-1359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2019 |
Last Update Date | 13/09/2019 |