Healthcare Provider Details

I. General information

NPI: 1073278255
Provider Name (Legal Business Name): IRENE ALDAY HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE J ALDAY PT

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 NEWNAN CROSSING BLVD E STE 100
NEWNAN GA
30265-2551
US

IV. Provider business mailing address

900 CIRCLE 75 PKWY SE STE 1700
ATLANTA GA
30339-3087
US

V. Phone/Fax

Practice location:
  • Phone: 770-460-4747
  • Fax:
Mailing address:
  • Phone: 678-673-5134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: