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General NPI Number Information
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NPI Number | 1851623045
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Entity Type | Individual
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Provider Name | KIMBERLY DAWN EDWARDS LPTA
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Gender | Female
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 282 WOODBERRY RD
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City | BASSETT
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State | VA
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Zip | 24055-3722
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Country | US
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Telephone | 276-734-5731
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Fax |
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Provider Business Mailing Address
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Address Line | 282 WOODBERRY RD
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City | BASSETT
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State | VA
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Zip | 24055-3722
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Country | US
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Telephone | 276-734-5731
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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 | 2306602705
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License Number State | VA
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