Provider Demographics
NPI:1689564601
Name:FREDERICK, SARAH C (DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:C
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 S FULTON AVE UNIT 1225
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1763
Mailing Address - Country:US
Mailing Address - Phone:812-345-0795
Mailing Address - Fax:
Practice Address - Street 1:40 GREENWAY CT STE B&C
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2326
Practice Address - Country:US
Practice Address - Phone:770-502-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist