MEDICARE: DREW EDMONDSON LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019016225	VA

General Provider Information

NPI Number	:	1215744818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DREW EDMONDSON LMT

Provider Business Mailing Address
First Line	:	1445 E RIO RD STE 201F
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-1751
Country	:	US
Telephone Number	:	434-872-1893
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 E RIO RD STE 201F
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-1751
Country	:	US
Telephone Number	:	434-872-1893
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	12/17/2024

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