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General NPI Number Information
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NPI Number | 1265383764
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Entity Type | Individual
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Provider Name | ANDREA HENAO
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Gender | Female
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 3370 SUGARLOAF PKWY STE B4B5
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5478
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Country | US
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Telephone | 470-706-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 3724 ROXTREE TRCE
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City | BUFORD
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State | GA
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Zip | 30518-8500
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Country | US
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Telephone | 678-736-0186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT018148
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License Number State | GA
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