Provider Demographics
NPI:1437930237
Name:EDGE, MAEGHAN (PTA)
Entity Type:Individual
Prefix:
First Name:MAEGHAN
Middle Name:
Last Name:EDGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 HARLESTON RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2432
Mailing Address - Country:US
Mailing Address - Phone:803-269-9174
Mailing Address - Fax:
Practice Address - Street 1:1 STILL HOPES DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-7164
Practice Address - Country:US
Practice Address - Phone:803-796-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3906208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation