Healthcare Provider Details

I. General information

NPI: 1588601520
Provider Name (Legal Business Name): CHARLIE DAVID EDWARDS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E ARLINGTON BLVD SUITE A
GREENVILLE NC
27858-7850
US

IV. Provider business mailing address

1350 E ARLINGTON BLVD SUITE A KINETIC PHYSICAL THERAPY AND WELLNESS, INC.
GREENVILLE NC
27858-7850
US

V. Phone/Fax

Practice location:
  • Phone: 252-758-7048
  • Fax: 252-215-5614
Mailing address:
  • Phone: 252-364-2806
  • Fax: 252-364-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: