Provider Demographics
NPI:1376638221
Name:EDGAR, ABBY EMMA MARIE (ATC/R)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:EMMA MARIE
Last Name:EDGAR
Suffix:
Gender:F
Credentials:ATC/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17204 EMBERS AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7336
Mailing Address - Country:US
Mailing Address - Phone:952-460-6349
Mailing Address - Fax:
Practice Address - Street 1:2004 RANDOLPH AVE
Practice Address - Street 2:F-18
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1750
Practice Address - Country:US
Practice Address - Phone:651-690-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer