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General NPI Number Information
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NPI Number | 1467671537
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Entity Type | Individual
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Provider Name | DORIS T EDMONDS PTA
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21905 US HIGHWAY 19 N
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City | CLEARWATER
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State | FL
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Zip | 33765-2342
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Country | US
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Telephone | 727-669-4245
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Fax | 727-669-6835
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Provider Business Mailing Address
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Address Line | 10331 BELLTOWER ST
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City | SPRING HILL
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State | FL
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Zip | 34608-2000
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Country | US
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Telephone | 352-666-5197
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA18930
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License Number State | FL
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