Provider Demographics
NPI:1164686994
Name:EDWARDS, EDWARD HAROLD (LMP)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:HAROLD
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 1ST CRK RD
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-9377
Mailing Address - Country:US
Mailing Address - Phone:509-687-9142
Mailing Address - Fax:
Practice Address - Street 1:988 1ST CRK RD
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9377
Practice Address - Country:US
Practice Address - Phone:509-687-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019634225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist