Provider Demographics
NPI:1285037853
Name:EDMUNDS, MICHAEL C
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:EDMUNDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2593 WEXFORD BAYNE RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8608
Mailing Address - Country:US
Mailing Address - Phone:412-292-1219
Mailing Address - Fax:
Practice Address - Street 1:2593 WEXFORD BAYNE RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8608
Practice Address - Country:US
Practice Address - Phone:412-292-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOH000112222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist