Basic Information
| Provider Information | |||||||||
| NPI: | 1518370865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAVAGE | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CPO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 WELBORN ST | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752193924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149049629 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2222 WELBORN ST | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752193924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145597440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2014 | ||||||||
| LastUpdateDate: | 02/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Z00000X | 58 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist | 224P00000X | 58 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Prosthetist |
No ID Information.