Provider Demographics
NPI:1285991653
Name:EDWARDS, DAVID (PTA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6290 N US HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47393-9743
Mailing Address - Country:US
Mailing Address - Phone:765-935-5410
Mailing Address - Fax:
Practice Address - Street 1:701 S OAK ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-2229
Practice Address - Country:US
Practice Address - Phone:765-584-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003412A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant