Provider Demographics
NPI:1457819781
Name:GAY, SAVANA
Entity Type:Individual
Prefix:
First Name:SAVANA
Middle Name:
Last Name:GAY
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 1:7236 NICKLAUS CIR
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1681
Mailing Address - Country:US
Mailing Address - Phone:571-241-1220
Mailing Address - Fax:
Practice Address - Street 1:7236 NICKLAUS CIR
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-1681
Practice Address - Country:US
Practice Address - Phone:571-241-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603878225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant