MEDICARE: EDGE PHYSICAL MEDICINE 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1477090371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGE PHYSICAL MEDICINE INC

Provider Business Mailing Address
First Line	:	PO BOX 37471
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45222-0471
Country	:	US
Telephone Number	:	513-413-1862
Fax Number	:	513-821-7243

Provider Business Practice Location Address
First Line	:	7364 READING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3451
Country	:	US
Telephone Number	:	513-413-1862
Fax Number	:	513-821-7243

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REBECCA ANNE SINGH
Credential	:	DC
Telephone Number	:	513-761-7246

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	11/14/2020

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