MEDICARE: DR. ANDREA MICHELLE CHARBENEAU DPT

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	225100000X	Physical Therapist	PT009144	GA

General Provider Information

NPI Number	:	1851569396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA MICHELLE CHARBENEAU DPT

Provider Business Mailing Address
First Line	:	2770 LENOX RD NE
Second Line	:	SUITE 120
City	:	ATLANTA
State	:	GA
Zip	:	30324-6006
Country	:	US
Telephone Number	:	404-364-9551
Fax Number	:	404-261-0617

Provider Business Practice Location Address
First Line	:	2770 LENOX RD NE
Second Line	:	SUITE 120
City	:	ATLANTA
State	:	GA
Zip	:	30324-6006
Country	:	US
Telephone Number	:	404-364-9551
Fax Number	:	404-261-0617

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

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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