Provider Demographics
NPI:1831523265
Name:SAVILLE, JESSICA WALLACE (DPT, PT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:WALLACE
Last Name:SAVILLE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:916 LOGANVILLE HWY
Practice Address - Street 2:STE 1130
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2144
Practice Address - Country:US
Practice Address - Phone:404-671-9525
Practice Address - Fax:404-671-9526
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist