Provider Demographics
NPI:1477829174
Name:FLAMAND, EDWARD R (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:FLAMAND
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 W WICKENBURG WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2262
Mailing Address - Country:US
Mailing Address - Phone:928-668-0108
Mailing Address - Fax:928-668-0110
Practice Address - Street 1:1175 W WICKENBURG WAY STE 3
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2262
Practice Address - Country:US
Practice Address - Phone:928-668-0108
Practice Address - Fax:928-668-0110
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104774Medicaid
AZP01623030OtherRAILROAD MEDICARE
AZZ1186507OtherMEDICARE