Provider Demographics
NPI:1952480204
Name:HEATON, SARAH LIQUORI (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LIQUORI
Last Name:HEATON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:LIQUORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-0518
Mailing Address - Country:US
Mailing Address - Phone:770-631-8277
Mailing Address - Fax:770-631-9403
Practice Address - Street 1:1720 PEACHTREE ST NW
Practice Address - Street 2:SUITE 422
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2449
Practice Address - Country:US
Practice Address - Phone:404-733-1936
Practice Address - Fax:404-733-1940
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT007930OtherSTATE LISC NUMBER