Healthcare Provider Details

I. General information

NPI: 1841107034
Provider Name (Legal Business Name): SAVANNAH PRIDGEN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 S PROVIDENCE RD STE 100
WAXHAW NC
28173-6310
US

IV. Provider business mailing address

PO BOX 601791
CHARLOTTE NC
28260-1791
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-8640
  • Fax: 704-384-8675
Mailing address:
  • Phone: 336-718-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25242
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: