Provider Demographics
NPI:1790468205
Name:ASTORGA, BRIANA MONIQUE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:MONIQUE
Last Name:ASTORGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SHALLOWFORD RD NE APT 4103
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1222
Mailing Address - Country:US
Mailing Address - Phone:470-760-9394
Mailing Address - Fax:
Practice Address - Street 1:4121 STEVE REYNOLDS BLVD UNIT 201
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3060
Practice Address - Country:US
Practice Address - Phone:470-448-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003668225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant