Provider Demographics
NPI:1053306498
Name:MCKAY, TRAVIS J (DPT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:J
Last Name:MCKAY
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 1:1920 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3529
Mailing Address - Country:US
Mailing Address - Phone:310-429-1754
Mailing Address - Fax:
Practice Address - Street 1:4614 DEL AMO BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1939
Practice Address - Country:US
Practice Address - Phone:310-974-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT28704AMedicare ID - Type UnspecifiedPERFORMING PROVIDER ID#