Provider Demographics
NPI:1386682649
Name:O'NEAL, ANDREA VARGAS (MPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:VARGAS
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:4261 FLIPPEN TRL
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3927
Mailing Address - Country:US
Mailing Address - Phone:404-931-7248
Mailing Address - Fax:
Practice Address - Street 1:1930 BOBBY JONES DR
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2402
Practice Address - Country:US
Practice Address - Phone:404-931-7248
Practice Address - Fax:404-920-2154
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26941225100000X
GAPT008107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA220541280AMedicaid
GA200801OtherBCBS GA
GA220541280AMedicaid