Healthcare Provider Details

I. General information

NPI: 1790892180
Provider Name (Legal Business Name): EDGAR TERHUNE SAVIDGE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CAMBRIDGE ST 4TH FLOOR
BOSTON MA
02114-2743
US

IV. Provider business mailing address

32 WOODWARD ST #3
SOUTH BOSTON MA
02127-2734
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-1230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number15915
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: