Healthcare Provider Details

I. General information

NPI: 1457718058
Provider Name (Legal Business Name): ANTHONY SAVIOLA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MAIN ST STE 150
OREGON CITY OR
97045-1868
US

IV. Provider business mailing address

24135 SW GRAHAMS FERRY RD
SHERWOOD OR
97140-7218
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-4877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-10150340
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: