Provider Demographics
NPI:1932864436
Name:TABOR, ANDREA J (LMT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:TABOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:J
Other - Last Name:SILVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10525 MORTON CHASE WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5697
Mailing Address - Country:US
Mailing Address - Phone:404-428-8266
Mailing Address - Fax:
Practice Address - Street 1:10525 MORTON CHASE WAY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5697
Practice Address - Country:US
Practice Address - Phone:404-428-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist