Provider Demographics
NPI:1003060526
Name:SEGEL, EDWARD DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:DAVID
Last Name:SEGEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2463
Mailing Address - Country:US
Mailing Address - Phone:617-731-1004
Mailing Address - Fax:617-731-1001
Practice Address - Street 1:524 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2463
Practice Address - Country:US
Practice Address - Phone:617-731-1004
Practice Address - Fax:617-731-1001
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182162251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic