Basic Information
| Provider Information | |||||||||
| NPI: | 1306998778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REEVES | ||||||||
| FirstName: | SAVANNAH | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 MCDONOUGH RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302331524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707757861 | ||||||||
| FaxNumber: | 7707756263 | ||||||||
| Practice Location | |||||||||
| Address1: | 747 S 8TH ST STE D | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302244884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702296498 | ||||||||
| FaxNumber: | 7702296598 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT003098 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 627792952A | 05 | GA | MEDICAID | NONE | 01 | GA | NONE | OTHER |