MEDICARE: MRS. HOLLY LYNN EDWARDS PTA

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	225200000X	Physical Therapy Assistant	2754	MA

General Provider Information

NPI Number	:	1225226723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY LYNN EDWARDS PTA

Provider Business Mailing Address
First Line	:	55 MAIN ST UNIT 1
Second Line	:
City	:	FAIRHAVEN
State	:	MA
Zip	:	02719-2984
Country	:	US
Telephone Number	:	508-965-4837
Fax Number	:

Provider Business Practice Location Address
First Line	:	567 DARTMOUTH ST
Second Line	:
City	:	SOUTH DARTMOUTH
State	:	MA
Zip	:	02748-1826
Country	:	US
Telephone Number	:	508-997-7787
Fax Number	:

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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