Individual
MR. TRAVIS L DESSOFFY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1025 WH SMITH BLVD STE 108, GREENVILLE, NC 27834-5278
(252) 215-2215
Mailing address
5172 US HIGHWAY 264 E, GREENVILLE, NC 27834-5805
(252) 908-3731
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO02116
NC
224P00000X
Prosthetist
Primary
CPO02116
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376663534
—
NC
Enumeration date
03/30/2007
Last updated
06/18/2019
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