MEDICARE: DR. GREGORY C. EDWARDS PT, DPT, CEEAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT018407	OH
2	225100000X	Physical Therapist	40QA01580400	NJ
3	225100000X	Physical Therapist	PT017585	GA

General Provider Information

NPI Number	:	1073907093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY C. EDWARDS PT, DPT, CEEAA

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 FURYS FERRY RD
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-9057
Country	:	US
Telephone Number	:	706-210-9380
Fax Number	:	706-650-1896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	05/13/2026

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