Provider Demographics
NPI:1508004508
Name:SAVAGE, GRETTA LYN (LMT)
Entity Type:Individual
Prefix:
First Name:GRETTA
Middle Name:LYN
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 RIVER ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3282
Mailing Address - Country:US
Mailing Address - Phone:518-698-7757
Mailing Address - Fax:
Practice Address - Street 1:255 RIVER ST
Practice Address - Street 2:SUITE 8
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3282
Practice Address - Country:US
Practice Address - Phone:518-698-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017428-1173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist