Provider Demographics
NPI:1861543977
Name:SAVAGEAU, MICHAEL PETER (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PETER
Last Name:SAVAGEAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:PETER
Other - Last Name:SAVAGEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1236 BRIDGEPORT CT NW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4919
Mailing Address - Country:US
Mailing Address - Phone:320-219-9680
Mailing Address - Fax:320-759-1080
Practice Address - Street 1:700 CEDAR ST STE 153
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1769
Practice Address - Country:US
Practice Address - Phone:320-219-9680
Practice Address - Fax:320-759-1080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN212560900Medicaid