Provider Demographics
NPI:1588352033
Name:SAVAGE, JOHN RYAN (LMT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RYAN
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 GRAND BROOK CIR APT 1323B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6912
Mailing Address - Country:US
Mailing Address - Phone:407-448-2645
Mailing Address - Fax:
Practice Address - Street 1:1030 DUNHURST CT
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-7054
Practice Address - Country:US
Practice Address - Phone:407-448-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA84269172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist