Provider Demographics
NPI:1922020361
Name:SAPP, JOSEPH MELVIN (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MELVIN
Last Name:SAPP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MASHBURN ST 102
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-4961
Mailing Address - Country:US
Mailing Address - Phone:478-783-4460
Mailing Address - Fax:478-783-4466
Practice Address - Street 1:3051 WATSON BLVD 525
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8556
Practice Address - Country:US
Practice Address - Phone:478-953-4563
Practice Address - Fax:478-953-4564
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000754619BMedicaid
GA175098Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #