Healthcare Provider Details

I. General information

NPI: 1306998778
Provider Name (Legal Business Name): SAVANNAH REEVES PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 S 8TH ST STE D
GRIFFIN GA
30224-4884
US

IV. Provider business mailing address

1050 MCDONOUGH RD
JACKSON GA
30233-1524
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6498
  • Fax: 770-229-6598
Mailing address:
  • Phone: 770-775-7861
  • Fax: 770-775-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003098
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: