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General NPI Number Information
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NPI Number | 1366254211
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Entity Type | Organization
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Legal Business Name | EDGE DIAGNOSTICS
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 5221 POCATELLA CT
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City | CAPE CORAL
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State | FL
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Zip | 33904-5835
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Country | US
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Telephone | 239-292-6498
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Fax | 239-984-1343
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Provider Business Mailing Address
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Address Line | 5221 POCATELLA CT
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City | CAPE CORAL
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State | FL
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Zip | 33904-5835
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Country | US
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Telephone | 239-292-6498
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SCOTT ALLAN BRADLEY
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Credential |
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Telephone | 239-292-6498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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