1528209301 NPI number — MISS REBECCA LYNN EDWARDS LAT, ATC

Table of content: MISS REBECCA LYNN EDWARDS LAT, ATC (NPI 1528209301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528209301 NPI number — MISS REBECCA LYNN EDWARDS LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
REBECCA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LAT, ATC
Provider Gender Code:
F

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:
1528209301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11200 GOVERNOR MANLY WAY
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27614-8599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-562-9410
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11200 GOVERNOR MANLY WAY
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27614-8599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-562-9410
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  1474 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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