Healthcare Provider Details

I. General information

NPI: 1891616090
Provider Name (Legal Business Name): KRISTA EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 HOLCOMB BRIDGE RD STE 205
ROSWELL GA
30076-4715
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 678-619-0003
  • Fax: 678-619-0004
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA005541
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: