Provider Demographics
NPI:1972615904
Name:SAVANT, DEANNA BRODKE (PT)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:BRODKE
Last Name:SAVANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3718 GRAND AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1544
Mailing Address - Country:US
Mailing Address - Phone:510-893-8878
Mailing Address - Fax:510-893-8879
Practice Address - Street 1:3468 MT. DIABLO BLVD
Practice Address - Street 2:SUITE B110
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-7105
Practice Address - Country:US
Practice Address - Phone:925-284-6150
Practice Address - Fax:925-284-6155
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ17431ZMedicare PIN