Provider Demographics
NPI:1396359386
Name:PRATT, SARA ELAINE (LMT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELAINE
Last Name:PRATT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SIGMAN RD NE
Mailing Address - Street 2:APT W180
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012
Mailing Address - Country:US
Mailing Address - Phone:404-397-9473
Mailing Address - Fax:
Practice Address - Street 1:1150 SIGMAN RD NE APT W180
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3867
Practice Address - Country:US
Practice Address - Phone:678-379-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009889225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist