Provider Demographics
NPI:1164713616
Name:EDWARDS, TOMMY RICHARD JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:RICHARD
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 STAG RUN BLVD
Mailing Address - Street 2:APT# 1015
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1861
Mailing Address - Country:US
Mailing Address - Phone:337-238-8526
Mailing Address - Fax:
Practice Address - Street 1:8601 4TH ST N
Practice Address - Street 2:SUITE#101
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3108
Practice Address - Country:US
Practice Address - Phone:727-579-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist