Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 40QA01580400 | NJ |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT018407 | OH |
NPI | 1073907093 |
---|---|
Provider Name | Dr. Gregory C. Edwards |
First Address | Dublin, OH 43016-8580 |
Second Address | Dublin, OH 43016-8580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 13/02/2020 |