Provider Demographics
NPI:1255650545
Name:SAVAGE, JEFFREY S (PTA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E WILLOW ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-1867
Mailing Address - Country:US
Mailing Address - Phone:815-634-3550
Mailing Address - Fax:815-634-0236
Practice Address - Street 1:35 E WILLOW ST
Practice Address - Street 2:SUITE A
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1867
Practice Address - Country:US
Practice Address - Phone:815-634-3550
Practice Address - Fax:815-634-0236
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160001146225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant