Provider Demographics
NPI:1275046609
Name:EDWARDS, DANA ARIEL (LAT,ATC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:ARIEL
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8970 SW 122ND PL APT 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4110
Mailing Address - Country:US
Mailing Address - Phone:706-202-1188
Mailing Address - Fax:
Practice Address - Street 1:1701 NE 127TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2518
Practice Address - Country:US
Practice Address - Phone:305-892-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL48752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer