Provider Demographics
NPI:1467671537
Name:EDMONDS, DORIS T (PTA)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:T
Last Name:EDMONDS
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 1:10331 BELLTOWER ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-2000
Mailing Address - Country:US
Mailing Address - Phone:352-666-5197
Mailing Address - Fax:
Practice Address - Street 1:21905 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2342
Practice Address - Country:US
Practice Address - Phone:727-669-4245
Practice Address - Fax:727-669-6835
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18930225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant