Provider Demographics
NPI:1235249293
Name:LEGETTE, SANDRA MARKS (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARKS
Last Name:LEGETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UPTON MILL DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-4015
Mailing Address - Country:US
Mailing Address - Phone:706-678-4531
Mailing Address - Fax:706-678-3285
Practice Address - Street 1:200 UPTON MILL DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-4015
Practice Address - Country:US
Practice Address - Phone:706-678-4531
Practice Address - Fax:706-678-3285
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2346242Medicaid