MEDICARE: ABBY CATHERINE EDWARDS PTA

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	225200000X	Physical Therapy Assistant	PTA4373	AR

General Provider Information

NPI Number	:	1326526484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY CATHERINE EDWARDS PTA

Provider Business Mailing Address
First Line	:	120 PENNY LN
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72501-8507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 HARRISON ST
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72501-7424
Country	:	US
Telephone Number	:	870-805-5793
Fax Number	:	870-569-8063

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

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	08/01/2018

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