Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports |
NPI | 1174020945 |
---|---|
Provider Name | Amber Edwards |
First Address | Huntington, WV 25701-3414 |
Second Address | Huntington, WV 25755-0003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2018 |
Last Update Date | 09/04/2018 |