Active NPI
Kristy Travis, PT, DPT
- Physical Therapist
- Carbondale, IL
National Provider Identifier
1124636584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070023683
- Practice address
- 1237 E Main St
Carbondale, IL 62901-3148 - Phone
- (618) 549-0721
- NPI assigned
- Jul 21, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070023683 | IL | Primary |
Addresses
Primary practice location
1237 E Main St
Carbondale, IL 62901-3148
Mailing address
13317 Davidson Rd
Marion, IL 62959-8250
Phone (618) 889-8044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070023683 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595289600000",
"number": "1124636584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13317 DAVIDSON RD",
"city": "MARION",
"state": "IL",
"postal_code": "629598250",
"telephone_number": "618-889-8044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1237 E MAIN ST",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629013148",
"telephone_number": "618-549-0721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAVIS",
"first_name": "KRISTY",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-21",
"last_updated": "2020-07-21",
"certification_date": "2020-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070023683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.