Provider Demographics
NPI:1972735843
Name:EDWARDS, JOSEPH JACKSON III (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JACKSON
Last Name:EDWARDS
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:507 STINSON DR
Mailing Address - Street 2:UNIT G2
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6221
Mailing Address - Country:US
Mailing Address - Phone:843-810-9490
Mailing Address - Fax:
Practice Address - Street 1:4390 BELLE OAKS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8559
Practice Address - Country:US
Practice Address - Phone:866-571-2700
Practice Address - Fax:877-571-2124
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2355225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant