MEDICARE: SAVANNAH REEVES PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT003098	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NONE	OTHER	GA	NONE

General Provider Information

NPI Number	:	1306998778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH REEVES PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1050 MCDONOUGH RD
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-1524
Country	:	US
Telephone Number	:	770-775-7861
Fax Number	:	770-775-6263

Provider Business Practice Location Address
First Line	:	747 S 8TH ST STE D
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4884
Country	:	US
Telephone Number	:	770-229-6498
Fax Number	:	770-229-6598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	01/09/2020

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