Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 005519 | OH |
N | 2251G0304X | Physical Therapist - Geriatrics | 1164473 | TX |
NPI | 1336455229 |
---|---|
Provider Name | Ms. Teresa Ann Edwards |
First Address | Garfield Heights, OH 44125-1226 |
Second Address | Kent, OH 44240-1814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2010 |
Last Update Date | 30/08/2010 |