Provider Demographics
NPI:1134104383
Name:EDWARDS, STEVEN LAYNE (MPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LAYNE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 S RAINBOW BLVD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2541
Mailing Address - Country:US
Mailing Address - Phone:702-876-9737
Mailing Address - Fax:702-876-9741
Practice Address - Street 1:6040 S RAINBOW BLVD
Practice Address - Street 2:SUITE B-1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2541
Practice Address - Country:US
Practice Address - Phone:702-876-9737
Practice Address - Fax:702-876-9741
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100142Medicare PIN