Provider Demographics
NPI:1114082815
Name:EDELMAN, ERIC RUSSELL (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:RUSSELL
Last Name:EDELMAN
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 1:33 POND ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5336
Mailing Address - Country:US
Mailing Address - Phone:617-504-3358
Mailing Address - Fax:
Practice Address - Street 1:150 PARKINGWAY ST
Practice Address - Street 2:#2
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5058
Practice Address - Country:US
Practice Address - Phone:617-328-1242
Practice Address - Fax:617-328-3386
Is Sole Proprietor?:No
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT10385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist