Provider Demographics
NPI:1174165476
Name:SAVAGE, GORDON LEWIS (PT)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:LEWIS
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 LEAVENWORTH ST STE 350A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-1121
Mailing Address - Country:US
Mailing Address - Phone:415-749-4200
Mailing Address - Fax:
Practice Address - Street 1:2800 LEAVENWORTH ST STE 350A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-1121
Practice Address - Country:US
Practice Address - Phone:415-749-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60961686225100000X
CA297904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist