Provider Demographics
NPI:1225015241
Name:EDWARDS, DOUGLAS WAYNE (ATC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N MAHAFFIE ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6430
Mailing Address - Country:US
Mailing Address - Phone:913-780-4659
Mailing Address - Fax:
Practice Address - Street 1:7931 BOND ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1557
Practice Address - Country:US
Practice Address - Phone:913-754-0888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer