Provider Demographics
NPI:1194018606
Name:EDMOND, VALERIE (PTA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:EDMOND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 CURTIS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1053
Mailing Address - Country:US
Mailing Address - Phone:510-527-8339
Mailing Address - Fax:
Practice Address - Street 1:1329 CURTIS ST
Practice Address - Street 2:SUITE A
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1053
Practice Address - Country:US
Practice Address - Phone:510-527-8339
Practice Address - Fax:924-254-8755
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT284225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant