MEDICARE: ANDREA HENAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT018148	GA

General Provider Information

NPI Number	:	1265383764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA HENAO

Provider Business Mailing Address
First Line	:	3724 ROXTREE TRCE
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30518-8500
Country	:	US
Telephone Number	:	678-736-0186
Fax Number	:

Provider Business Practice Location Address
First Line	:	3370 SUGARLOAF PKWY STE B4B5
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5478
Country	:	US
Telephone Number	:	470-706-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ ANDREA HENAO ” Practice Location

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