Provider Demographics
NPI:1154360980
Name:EDWARDS, JANICE (PT)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7925
Mailing Address - Country:US
Mailing Address - Phone:817-641-8617
Mailing Address - Fax:817-641-8620
Practice Address - Street 1:1014 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7925
Practice Address - Country:US
Practice Address - Phone:817-641-8617
Practice Address - Fax:817-641-8620
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153519701Medicaid
TX650024546OtherRAILROAD MEDICARE PIN
TX8695B9Medicare PIN
TX153519701Medicaid