Healthcare Provider Details

I. General information

NPI: 1174020945
Provider Name (Legal Business Name): AMBER EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOHN MARSHALL DR
HUNTINGTON WV
25755-0003
US

IV. Provider business mailing address

946 12TH AVE
HUNTINGTON WV
25701-3414
US

V. Phone/Fax

Practice location:
  • Phone: 205-292-6504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: