Healthcare Provider Details
I. General information
NPI: 1265960819
Provider Name (Legal Business Name): JULIE KATELYN SAVAGE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/26/2017
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3575 KEITH ST NW STE 205
CLEVELAND TN
37312-4326
US
IV. Provider business mailing address
8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US
V. Phone/Fax
- Phone: 423-559-0444
- Fax: 423-559-0103
- Phone: 423-238-8930
- Fax: 423-254-5217
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2255A2300X |
| Taxonomy | Athletic Trainer |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: