Healthcare Provider Details

I. General information

NPI: 1346497013
Provider Name (Legal Business Name): GLENN ALLEN EDWARDS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

9100 BABCOCK BLVD
PITTSBURGH PA
15237-5815
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-4305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012462L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: