Provider Demographics
NPI:1255096657
Name:SAVILLA, CHARLES MANVILLE III
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MANVILLE
Last Name:SAVILLA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:ELEANOR
Mailing Address - State:WV
Mailing Address - Zip Code:25070-1207
Mailing Address - Country:US
Mailing Address - Phone:304-932-8776
Mailing Address - Fax:
Practice Address - Street 1:101 BEECH ST
Practice Address - Street 2:
Practice Address - City:ELEANOR
Practice Address - State:WV
Practice Address - Zip Code:25070-1391
Practice Address - Country:US
Practice Address - Phone:304-932-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer