| Organization Name: | TRAVIS PEDIATRIC THERAPY CENTER, PLLC |
| NPI Number: | 1548515141 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERI LYNN TRAVIS (OWNER/SPEECH LANGUAGE PATHOLOGIST) |
| Mailing Address: | 8117 Gladys Ave Suite 103 Beaumont |
| State: | TX US |
| Postal Code: | 777064000 |
| Phone Number: | 4098611000 |
| Fax Number: | 4098612241 |
| NPI Enumeration Date: | 07/19/2012 |
| NPI Last Update Date: | 07/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 17454 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |