Provider Demographics
NPI:1134667124
Name:COOPER, SARAH REGINA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:REGINA
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:REGINA
Other - Last Name:D'URSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1048 PARKMIST DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7276
Mailing Address - Country:US
Mailing Address - Phone:678-993-5429
Mailing Address - Fax:
Practice Address - Street 1:4045 JOHNS CREEK PKWY
Practice Address - Street 2:BLDG B, SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-206-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist