Provider Demographics
NPI:1780031500
Name:FABIEN, SAVANNAH (DPT)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:FABIEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TIDBALL RD
Mailing Address - Street 2:
Mailing Address - City:FORT MONROE
Mailing Address - State:VA
Mailing Address - Zip Code:23651-1071
Mailing Address - Country:US
Mailing Address - Phone:252-367-8720
Mailing Address - Fax:
Practice Address - Street 1:1618 HARDY CASH DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2400
Practice Address - Country:US
Practice Address - Phone:757-838-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-22
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist