Provider Demographics
NPI:1396939039
Name:EDWARDS, KEVIN WAYNE (PT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WAYNE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:240 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1553
Mailing Address - Country:US
Mailing Address - Phone:724-203-0420
Mailing Address - Fax:724-869-0195
Practice Address - Street 1:3950 BRODHEAD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3030
Practice Address - Country:US
Practice Address - Phone:724-774-8245
Practice Address - Fax:724-774-0168
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011338L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397613Medicare PIN