Provider Demographics
NPI:1467450536
Name:EDMONDSON PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:EDMONDSON PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:330-386-5093
Mailing Address - Street 1:423 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-3129
Mailing Address - Country:US
Mailing Address - Phone:330-386-5093
Mailing Address - Fax:330-386-0571
Practice Address - Street 1:423 WALNUT ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3129
Practice Address - Country:US
Practice Address - Phone:330-386-5093
Practice Address - Fax:330-386-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000132452OtherATHEM BC/BS PROVDER #
OH551723127001OtherMEDICAL MUTUAL OHIO
OHA131408OtherREHABILICARE
OH0921220Medicaid
PA204068OtherUPMC PROVIDER
PA197528OtherHIGHMARK BCBS PROV NUMBER
OH000000132452OtherATHEM BC/BS PROVDER #
PA204068OtherUPMC PROVIDER
OH551723127001OtherMEDICAL MUTUAL OHIO
OHA131408OtherREHABILICARE