Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 05010652A | IN |
NPI | 1285302596 |
---|---|
Provider Name | David Edwards |
First Address | Indianapolis, IN 46202-2207 |
Second Address | Indianapolis, IN 46202-2394 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2021 |
Last Update Date | 01/09/2021 |