Provider Demographics
NPI:1427391416
Name:EDWARDS, DANETTE K (PT)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:K
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANETTE
Other - Middle Name:K
Other - Last Name:EDWARDS-ACKERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4520 N 12TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4233
Mailing Address - Country:US
Mailing Address - Phone:602-368-8317
Mailing Address - Fax:602-419-2067
Practice Address - Street 1:4520 N 12TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4233
Practice Address - Country:US
Practice Address - Phone:602-368-8317
Practice Address - Fax:602-419-2067
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist