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General NPI Number Information
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NPI Number | 1164494977
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Entity Type | Individual
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Provider Name | STEPHEN LERON EDMONDS MPT
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Gender | Male
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 5308 RIVER EDGE RD
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City | NORFOLK
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State | VA
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Zip | 23502-3509
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Country | US
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Telephone | 757-971-3464
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Fax | 757-423-8298
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Provider Business Mailing Address
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Address Line | 5308 RIVER EDGE RD
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City | NORFOLK
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State | VA
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Zip | 23502-3509
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Country | US
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Telephone | 757-971-3464
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Fax | 757-423-8298
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305202617
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License Number State | VA
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