Provider Demographics
NPI:1023229101
Name:HELTON, OMANDA ALISHA (PTA)
Entity type:Individual
Prefix:
First Name:OMANDA
Middle Name:ALISHA
Last Name:HELTON
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 1:236 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:GA
Mailing Address - Zip Code:30563-3661
Mailing Address - Country:US
Mailing Address - Phone:706-968-4047
Mailing Address - Fax:
Practice Address - Street 1:386 BELAIRE DR
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3313
Practice Address - Country:US
Practice Address - Phone:706-896-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002357225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant