Provider Demographics
NPI:1265818744
Name:EDWARDS, KATHERINE ALDEN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ALDEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E MOREHEAD ST STE 190
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2946
Mailing Address - Country:US
Mailing Address - Phone:919-619-8231
Mailing Address - Fax:
Practice Address - Street 1:1200 E MOREHEAD ST STE 190
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:919-619-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist