Provider Demographics
NPI:1447482856
Name:LEDOYT, TRAVIS JAMES (DPT)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:JAMES
Last Name:LEDOYT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CORPORATE PL STE 103B
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3891
Mailing Address - Country:US
Mailing Address - Phone:978-535-1213
Mailing Address - Fax:
Practice Address - Street 1:100 CORPORATE PL STE 103B
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3891
Practice Address - Country:US
Practice Address - Phone:978-535-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist