Individual
HENRY IRAHETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12050 ETRIS RD STE E150, ROSWELL, GA 30075-8022
(770) 801-4657
Mailing address
121 CHARLES ST, ROCKVILLE, MD 20850-1510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT016262
GA
Other
Enumeration date
09/15/2022
Last updated
09/15/2022
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