Provider Demographics
NPI:1588957781
Name:LIGHT, SARAH E (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:LIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4505 ASHFORD DUNWOODY RD NE
Mailing Address - Street 2:STE 13
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1514
Mailing Address - Country:US
Mailing Address - Phone:770-393-0111
Mailing Address - Fax:770-393-0109
Practice Address - Street 1:4505 ASHFORD DUNWOODY RD NE
Practice Address - Street 2:STE 13
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-1514
Practice Address - Country:US
Practice Address - Phone:770-393-0111
Practice Address - Fax:770-393-0109
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT011251OtherLICENSE