Provider Demographics
NPI:1326923293
Name:RICHARDS, TRAVIS MICHAEL (CPO)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5541 MARTHAS MILL WAY
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-6868
Mailing Address - Country:US
Mailing Address - Phone:904-612-3241
Mailing Address - Fax:
Practice Address - Street 1:5541 MARTHAS MILL WAY
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-6868
Practice Address - Country:US
Practice Address - Phone:904-612-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR139335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier