Provider Demographics
NPI:1275397770
Name:HAYDEN-GRANT, ANDREA LORRAINE (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LORRAINE
Last Name:HAYDEN-GRANT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 CALEB WAY
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-6975
Mailing Address - Country:US
Mailing Address - Phone:706-834-7330
Mailing Address - Fax:
Practice Address - Street 1:1506 CALEB WAY
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-6975
Practice Address - Country:US
Practice Address - Phone:706-834-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002476225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant