Provider Demographics
NPI:1124107842
Name:APPLEGATE, STEPHANIE S (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SAWATSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:857 COLLIER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2544
Mailing Address - Country:US
Mailing Address - Phone:404-419-7760
Mailing Address - Fax:
Practice Address - Street 1:1901 PHOENIX BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5588
Practice Address - Country:US
Practice Address - Phone:770-907-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA007969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA007969OtherSTATE LISC NUMBER
GA202I658109Medicare PIN