Individual
ANDREW PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3206 PEACH ORCHARD RD, AUGUSTA, GA 30906-3540
(706) 798-9323
Mailing address
PO BOX 5545, AUGUSTA, GA 30916-5545
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT013750
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT013750
PHYSICAL THERAPIST LICENSE
GA
Enumeration date
11/15/2018
Last updated
11/15/2018
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