MEDICARE: ELIZABETH E EDMISTON PT

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	225100000X	Physical Therapist	PT2741	ME
2	225100000X	Physical Therapist	PT4461	MS

General Provider Information

NPI Number	:	1841251089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH E EDMISTON PT

Provider Business Mailing Address
First Line	:	607 RUE DAUPHINE
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3022
Country	:	US
Telephone Number	:	228-238-7714
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 GOVERNMENT ST STE A
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5647
Country	:	US
Telephone Number	:	228-238-7714
Fax Number	:	855-958-5398

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	11/10/2020

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Directions to “ ELIZABETH E EDMISTON PT” Practice Location

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