Provider Demographics
NPI:1073575965
Name:HARBIN, SANDRA E (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:HARBIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:E
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6001 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 1040
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5631
Mailing Address - Country:US
Mailing Address - Phone:770-489-3513
Mailing Address - Fax:678-715-5320
Practice Address - Street 1:6001 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 1040
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5631
Practice Address - Country:US
Practice Address - Phone:770-489-3513
Practice Address - Fax:678-715-5320
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0024652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ30230Medicare UPIN
GAQ30230Medicare UPIN