Provider Demographics
NPI:1962139006
Name:PATHEJA, SAVINA (DPT)
Entity type:Individual
Prefix:
First Name:SAVINA
Middle Name:
Last Name:PATHEJA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 COURT DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-2313
Mailing Address - Country:US
Mailing Address - Phone:803-507-0258
Mailing Address - Fax:
Practice Address - Street 1:109 COURT DR
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-2313
Practice Address - Country:US
Practice Address - Phone:803-507-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
GAPT016236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist