Provider Demographics
NPI:1487846614
Name:ANDRADA, EDWIN BANADOS (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:BANADOS
Last Name:ANDRADA
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Gender:M
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:2129 RIVERSIDE DR
Mailing Address - Street 2:STE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-6900
Mailing Address - Country:US
Mailing Address - Phone:478-741-9672
Mailing Address - Fax:478-741-9674
Practice Address - Street 1:2129 RIVERSIDE DR
Practice Address - Street 2:STE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-6900
Practice Address - Country:US
Practice Address - Phone:478-741-9672
Practice Address - Fax:478-741-9674
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2007-10-15
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Provider Licenses
StateLicense IDTaxonomies
GA4246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist