Healthcare Provider Details

I. General information

NPI: 1417868019
Provider Name (Legal Business Name): INNOVATE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 LAWNDALE DR
GREENSBORO NC
27455-1827
US

IV. Provider business mailing address

4113 LAWNDALE DR
GREENSBORO NC
27455-1827
US

V. Phone/Fax

Practice location:
  • Phone: 336-870-6621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SAVANNAH BURRUS
Title or Position: MANAGING MEMBER, OWNER
Credential: DPT
Phone: 336-870-6621