1467450536 NPI number — EDMONDSON PHYSICAL THERAPY, INC.

Table of content: (NPI 1467450536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467450536 NPI number — EDMONDSON PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDMONDSON PHYSICAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467450536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LIVERPOOL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43920-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-386-5093
Provider Business Mailing Address Fax Number:
330-386-0571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LIVERPOOL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43920-3129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-386-5093
Provider Business Practice Location Address Fax Number:
330-386-0571
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EDMONDSON
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
330-386-5093

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000132452 . This is a "ATHEM BC/BS PROVDER #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 551723127001 . This is a "MEDICAL MUTUAL OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: A131408 . This is a "REHABILICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0921220 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 204068 . This is a "UPMC PROVIDER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 197528 . This is a "HIGHMARK BCBS PROV NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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