Provider Demographics
NPI:1356982862
Name:IMUS, SAVANAH J
Entity type:Individual
Prefix:
First Name:SAVANAH
Middle Name:J
Last Name:IMUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 NE DIVISION ST STE 8
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-3570
Mailing Address - Country:US
Mailing Address - Phone:541-728-0932
Mailing Address - Fax:
Practice Address - Street 1:2330 NE DIVISION ST STE 8
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3570
Practice Address - Country:US
Practice Address - Phone:541-728-0932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-06
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist