Provider Demographics
NPI:1407334485
Name:ROTAP, SAVANNAH HAILEY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:HAILEY
Last Name:ROTAP
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16770 SW EDY RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9679
Mailing Address - Country:US
Mailing Address - Phone:503-216-9731
Mailing Address - Fax:503-216-9732
Practice Address - Street 1:16770 SW EDY RD STE 310
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9679
Practice Address - Country:US
Practice Address - Phone:503-216-9731
Practice Address - Fax:503-216-9732
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist