Provider Demographics
NPI:1043558125
Name:HARKINS, EDWARD CHARLES (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:CHARLES
Last Name:HARKINS
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 1:1225 S GRAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5289
Mailing Address - Country:US
Mailing Address - Phone:509-338-9204
Mailing Address - Fax:
Practice Address - Street 1:1225 S GRAND AVE STE B
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5289
Practice Address - Country:US
Practice Address - Phone:509-338-9204
Practice Address - Fax:509-338-9206
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00004052225100000X
IDPT606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist