Provider Demographics
NPI:1477711851
Name:EDWARDS, JUDY CAROLYN LEE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:CAROLYN LEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200GLENNWATERDRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-549-0807
Mailing Address - Fax:704-503-5481
Practice Address - Street 1:9200 GLENWATER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8557
Practice Address - Country:US
Practice Address - Phone:704-549-0807
Practice Address - Fax:704-503-5481
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant