Healthcare Provider Details

I. General information

NPI: 1609109701
Provider Name (Legal Business Name): THOMAS EVERETT EDMONDS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PERRY HILL RD
MONTGOMERY AL
36109-3725
US

IV. Provider business mailing address

2845 ZELDA RD UNIT P6
MONTGOMERY AL
36106-2604
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-4670
  • Fax:
Mailing address:
  • Phone: 540-408-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number0117002956
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number007621
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberA-3210
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number72159
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: