Healthcare Provider Details

I. General information

NPI: 1699189530
Provider Name (Legal Business Name): DALE ALWOOD EDWARDS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W 2ND ST
GOODLAND KS
67735-1660
US

IV. Provider business mailing address

425 ARROWHEAD ST
COLBY KS
67701-3611
US

V. Phone/Fax

Practice location:
  • Phone: 785-890-7517
  • Fax:
Mailing address:
  • Phone: 785-443-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-02107
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-02108
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: