Provider Demographics
NPI:1790260636
Name:BADGETT, SAVANNA LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:LYNN
Last Name:BADGETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 RED CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-7614
Mailing Address - Country:US
Mailing Address - Phone:336-710-1886
Mailing Address - Fax:
Practice Address - Street 1:204 OLD BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-8971
Practice Address - Country:US
Practice Address - Phone:336-667-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4461225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA4461OtherNC BOARD OF PHYSICAL THERAPY EXAMINERS PTA LICENSE