MEDICARE: EDMONDSON PHYSICAL THERAPY, INC.

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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000132452	OTHER	OH	ATHEM BC/BS PROVDER #
2	551723127001	OTHER	OH	MEDICAL MUTUAL OHIO
3	A131408	OTHER	OH	REHABILICARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	204068	OTHER	PA	UPMC PROVIDER
6	197528	OTHER	PA	HIGHMARK BCBS PROV NUMBER

General Provider Information

NPI Number	:	1467450536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDMONDSON PHYSICAL THERAPY, INC.

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

Provider Business Practice Location Address
First Line	:	423 WALNUT ST
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-3129
Country	:	US
Telephone Number	:	330-386-5093
Fax Number	:	330-386-0571

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	LYNN E EDMONDSON
Credential	:	LPT
Telephone Number	:	330-386-5093

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/07/2009

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Directions to “EDMONDSON PHYSICAL THERAPY, INC. ” Practice Location

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