Organization
LIFEWISE PHYSICAL MEDICINE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RHETT TRAVIS D.C. (OWNER)
(540) 400-7733
Entity
Organization
Contact information
Practice address
4633 BRAMBLETON AVE, ROANOKE, VA 24018-3410
(540) 400-7733
(540) 904-6009
Mailing address
4633 BRAMBLETON AVE, ROANOKE, VA 24018-3410
(540) 400-7733
(540) 904-6009
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
0104001882
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508935362
NPI NUMBER
VA
01
—
346267
ANTHEM
VA
01
—
346268
ANTHEM
VA
Enumeration date
03/06/2008
Last updated
11/06/2008
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