Healthcare Provider Details

I. General information

NPI: 1346853843
Provider Name (Legal Business Name): SAVANNAH LEA EGGEMEYER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 3RD ST
BORGER TX
79007-4008
US

IV. Provider business mailing address

PO BOX 207
GROOM TX
79039-0207
US

V. Phone/Fax

Practice location:
  • Phone: 806-274-9856
  • Fax:
Mailing address:
  • Phone: 325-234-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2156586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: