Healthcare Provider Details

I. General information

NPI: 1194986380
Provider Name (Legal Business Name): LONNIE STEVE SAPP JR. B.S.ED, PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N OAK ST BLDG A
VALDOSTA GA
31602-5902
US

IV. Provider business mailing address

2700 N OAK ST BLDG A
VALDOSTA GA
31602-5902
US

V. Phone/Fax

Practice location:
  • Phone: 229-249-9600
  • Fax:
Mailing address:
  • Phone: 229-249-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1220
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: