Provider Demographics
NPI:1366459505
Name:EDWARDS, PHILLIP M (PT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18780 COX AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4109
Mailing Address - Country:US
Mailing Address - Phone:408-973-7700
Mailing Address - Fax:408-973-1600
Practice Address - Street 1:12900 SARATOGA AVE
Practice Address - Street 2:STE A
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4666
Practice Address - Country:US
Practice Address - Phone:408-973-7700
Practice Address - Fax:408-973-1600
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT297260Medicare PIN