Provider Demographics
NPI:1518625946
Name:HARDELL, SARAH BURNETT (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:BURNETT
Last Name:HARDELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATHRYN
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1765 OLD WEST BROAD ST BLDG 2-200
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2887
Mailing Address - Country:US
Mailing Address - Phone:706-549-1663
Mailing Address - Fax:706-546-8792
Practice Address - Street 1:705 BREEDLOVE DR STE 200
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2080
Practice Address - Country:US
Practice Address - Phone:706-549-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN139132251X0800X
GAPT017439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN13913OtherBLUE CROSS BLUE SHIELD
TN13913OtherMEDICARE