Provider Demographics
NPI:1508496191
Name:HART, SAVANNAH DEANN
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:DEANN
Last Name:HART
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 1:265 COUNTY ROAD 2168
Mailing Address - Street 2:
Mailing Address - City:HARTMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72840-8809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:265 COUNTY ROAD 2168
Practice Address - Street 2:
Practice Address - City:HARTMAN
Practice Address - State:AR
Practice Address - Zip Code:72840-8809
Practice Address - Country:US
Practice Address - Phone:479-774-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer