Healthcare Provider Details

I. General information

NPI: 1588352033
Provider Name (Legal Business Name): JOHN RYAN SAVAGE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 DUNHURST CT
LONGWOOD FL
32779-7054
US

IV. Provider business mailing address

2115 GRAND BROOK CIR APT 1323B
ORLANDO FL
32810-6912
US

V. Phone/Fax

Practice location:
  • Phone: 407-448-2645
  • Fax:
Mailing address:
  • Phone: 407-448-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA84269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: