Provider Demographics
NPI:1194247403
Name:MARTIN, SARAH J (DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:LITWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2000 MIRROR LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-2124
Mailing Address - Country:US
Mailing Address - Phone:770-456-7877
Mailing Address - Fax:770-456-7880
Practice Address - Street 1:2000 MIRROR LAKE BLVD
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-2124
Practice Address - Country:US
Practice Address - Phone:770-456-7877
Practice Address - Fax:770-456-7880
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP061832251P0200X
GAPT014358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003229857Medicaid