Provider Demographics
NPI:1033285325
Name:ADDISON, EDWINA M (PTA PHYSICAL THERAPI)
Entity Type:Individual
Prefix:MS
First Name:EDWINA
Middle Name:M
Last Name:ADDISON
Suffix:
Gender:F
Credentials:PTA PHYSICAL THERAPI
Other - Prefix:
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Mailing Address - Street 1:260 REMINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:22903
Mailing Address - Country:US
Mailing Address - Phone:434-361-2650
Mailing Address - Fax:434-361-2511
Practice Address - Street 1:1543 BEECH GROVE ROAD
Practice Address - Street 2:NELSON PHYSICAL THERAPY
Practice Address - City:ROSELAND
Practice Address - State:VA
Practice Address - Zip Code:22967
Practice Address - Country:US
Practice Address - Phone:434-361-2650
Practice Address - Fax:434-361-2511
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2306602062224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant