Provider Demographics
NPI:1821561978
Name:WARNER, SAVANNAH (MSAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:MSAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW AVENUE M APT 422
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-3529
Mailing Address - Country:US
Mailing Address - Phone:254-595-2879
Mailing Address - Fax:
Practice Address - Street 1:7415 S US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-6202
Practice Address - Country:US
Practice Address - Phone:254-595-2879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2021-03-28
Deactivation Date:2019-01-12
Deactivation Code:
Reactivation Date:2019-01-23
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXAT84192083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program