Healthcare Provider Details

I. General information

NPI: 1477090371
Provider Name (Legal Business Name): EDGE PHYSICAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 11/14/2020
Certification Date: 11/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7364 READING RD
CINCINNATI OH
45237-3451
US

IV. Provider business mailing address

PO BOX 37471
CINCINNATI OH
45222-0471
US

V. Phone/Fax

Practice location:
  • Phone: 513-413-1862
  • Fax: 513-821-7243
Mailing address:
  • Phone: 513-413-1862
  • Fax: 513-821-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: REBECCA ANNE SINGH
Title or Position: PRESIDENT
Credential: DC
Phone: 513-761-7246