Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT9708 | GA |
NPI | 1003186537 |
---|---|
Provider Name | Andrea Nicole Henry |
First Address | Ooltewah, TN 37363-6511 |
Second Address | Calhoun, GA 30701-9383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2011 |
Last Update Date | 30/12/2011 |