Provider Demographics
NPI:1326784885
Name:NEAL, SAVANNAH PEYTON (DPT)
Entity Type:Individual
Prefix:MISS
First Name:SAVANNAH
Middle Name:PEYTON
Last Name:NEAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:PEYTON
Other - Last Name:DORKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 N WICKFORD CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2934
Mailing Address - Country:US
Mailing Address - Phone:318-347-4353
Mailing Address - Fax:
Practice Address - Street 1:403 E FLOURNOY LUCAS RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-3906
Practice Address - Country:US
Practice Address - Phone:318-347-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist