Healthcare Provider Details

I. General information

NPI: 1891660080
Provider Name (Legal Business Name): SAVANNAH LIEBENROOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S GERMANTOWN RD
GERMANTOWN TN
38138
US

IV. Provider business mailing address

573 ELKSTONE PL W APT 101
COLLIERVILLE TN
38017-4278
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-3180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number16682
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: