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General NPI Number Information
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NPI Number | 1275788218
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Entity Type | Individual
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Provider Name | ELIZABETH EDWARDS P.T
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Gender | Female
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 6849 OLD DOMINION DR STE 221
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City | MC LEAN
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State | VA
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Zip | 22101-3724
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Country | US
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Telephone | 703-848-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 11745 MOSSY CREEK LN
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City | RESTON
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State | VA
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Zip | 20191-2950
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Country | US
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Telephone | 571-357-0760
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 030602
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License Number State | NY
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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 | 23266
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305206778
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License Number State | VA
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