Provider Demographics
NPI:1215363809
Name:HIMES, SAVANAH
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:
Last Name:HIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ROSE SIDING RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-2407
Mailing Address - Country:US
Mailing Address - Phone:814-715-7032
Mailing Address - Fax:
Practice Address - Street 1:133 LAURELBROOKE DR
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2653
Practice Address - Country:US
Practice Address - Phone:814-849-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1003261225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant