Provider Demographics
NPI:1760920672
Name:BORGES, SAVANNAH (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:BORGES
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 TOWER ST APT 110
Mailing Address - Street 2:
Mailing Address - City:ST BONIFACIUS
Mailing Address - State:MN
Mailing Address - Zip Code:55375-1178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4075 TOWER ST APT 110
Practice Address - Street 2:
Practice Address - City:ST BONIFACIUS
Practice Address - State:MN
Practice Address - Zip Code:55375-1178
Practice Address - Country:US
Practice Address - Phone:920-979-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-11
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL51832255A2300X
MN33652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer