Provider Demographics
NPI:1033673371
Name:SARLEA, REBECCA CAPATA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CAPATA
Last Name:SARLEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 HOLLOW BROOK CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-2870
Mailing Address - Country:US
Mailing Address - Phone:954-681-2656
Mailing Address - Fax:
Practice Address - Street 1:425 BUFORD HWY STE 102
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2692
Practice Address - Country:US
Practice Address - Phone:954-681-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12532111N00000X
GA010159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor