Provider Demographics
NPI:1518403302
Name:SAVAGE, SYDNEY T (PT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:T
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11561 EDGERTON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9150
Mailing Address - Country:US
Mailing Address - Phone:616-866-2727
Mailing Address - Fax:616-866-2729
Practice Address - Street 1:11561 EDGERTON AVE NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9150
Practice Address - Country:US
Practice Address - Phone:616-866-2727
Practice Address - Fax:616-866-2729
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist