Provider Demographics
NPI:1205183779
Name:EDWARDS, AUBREY (PT)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1519
Mailing Address - Country:US
Mailing Address - Phone:806-771-8008
Mailing Address - Fax:806-771-8009
Practice Address - Street 1:4138 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2403
Practice Address - Country:US
Practice Address - Phone:806-780-2329
Practice Address - Fax:806-780-2330
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1221872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX540045100OtherFIRSTCARE
TX307116901Medicaid
TXP01152140OtherMEDICARE RAILROAD
TX307116902Medicaid
TX878T08OtherBLUE CROSS BLUE SHIELD
TX307116901Medicaid