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General NPI Number Information
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NPI Number | 1295679017
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Entity Type | Individual
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Provider Name | RICHARD BLAKE EDWARDS
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Gender | Male
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Dates
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Enumeration Date | 04/14/2026
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 1161 MCDERMOTT DR
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City | WEST CHESTER
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State | PA
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Zip | 19380-4064
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Country | US
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Telephone | 484-356-9401
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Fax |
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Provider Business Mailing Address
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Address Line | 630 SUNNYSIDE RD
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City | TAPPAHANNOCK
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State | VA
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Zip | 22560-5716
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Country | US
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Telephone | 804-238-4050
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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 |
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License Number State |
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