Healthcare Provider Details

I. General information

NPI: 1063376473
Provider Name (Legal Business Name): SAVANNAH HAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EVERGREEN DR STE 220
GLEN MILLS PA
19342-1059
US

IV. Provider business mailing address

PO BOX 34990
BELFAST ME
04915-0627
US

V. Phone/Fax

Practice location:
  • Phone: 610-579-3650
  • Fax: 833-941-3871
Mailing address:
  • Phone: 610-359-5672
  • Fax: 833-941-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT033813
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: