Provider Demographics
NPI:1104973445
Name:EDMUNDS, DORSETT
Entity type:Individual
Prefix:MS
First Name:DORSETT
Middle Name:
Last Name:EDMUNDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 N. ORACLE RD
Mailing Address - Street 2:STE #101 TUCSON PHYSICAL THERAPY
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704
Mailing Address - Country:US
Mailing Address - Phone:520-293-5551
Mailing Address - Fax:520-293-6638
Practice Address - Street 1:5501 N. ORACLE RD
Practice Address - Street 2:STE. #101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-293-5551
Practice Address - Fax:520-293-5551
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist