TRAVIS BOLSTAD, DPT — NPI 1194325712 (Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers

CMS-1500 Box 24J / 33a • NPI

1194325712

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

225100000X (CMS 65)

Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist

Box 32 Service Location & ZIP+4

400 22ND AVE, BROOKINGS, SD, 57006-2450

✓ 9-Digit EDI 837 ZIP+4 (57006-2450)

Practice Phone & Referral Fax

(605) 697-7336

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1194325712 (TRAVIS BOLSTAD, DPT) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1194325712` (NPI-1 Individual Practitioner)
Provider / Legal Name	TRAVIS BOLSTAD, DPT
Plain-English Specialty	Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist NUCC Code: `225100000X` (Physical Therapist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	400 22ND AVE, BROOKINGS, SD, 57006-2450
Practice Telephone / Fax	Tel: (605) 697-7336
Administrative Mailing Address	45790 216A ST, VOLGA, SD, 57071-6820
Enumeration & Last Sync	Enumerated: 2020-11-01 \| CMS Record Updated: 2020-11-01

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

400 22ND AVE, BROOKINGS, SD, 57006-2450

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Plain-English Taxonomy & CMS Crosswalk (225100000X)

What Does Taxonomy Code 225100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225100000X translates to:
"Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 65 (Physical Therapist in Private Practice)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physical Therapist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (TRAVIS BOLSTAD, DPT)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`225100000X` — Physical Therapist Plain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist	State: IA \| License: `097556` \| Primary: Secondary
`225100000X` — Physical Therapist Plain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist	State: SD \| License: `2166` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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TRAVIS BOLSTAD, DPT (NPI #1194325712)