Healthcare Provider Details

I. General information

NPI: 1366254211
Provider Name (Legal Business Name): EDGE DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TAMIAMI TRL UNIT 111
PUNTA GORDA FL
33950-5513
US

IV. Provider business mailing address

5221 POCATELLA CT
CAPE CORAL FL
33904-5835
US

V. Phone/Fax

Practice location:
  • Phone: 941-347-3650
  • Fax: 971-347-3651
Mailing address:
  • Phone: 239-292-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT ALLAN BRADLEY
Title or Position: CEO
Credential:
Phone: 239-292-6498