Healthcare Provider Details

I. General information

NPI: 1629188891
Provider Name (Legal Business Name): CHARLES KYLE SAVINO MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W 89TH AVE W2
MERRILLVILLE IN
46410-7073
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 219-791-0494
  • Fax: 219-791-0490
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05008926A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: