Provider Demographics
NPI:1518484872
Name:EDGECOMB, COURTNEY (PT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:EDGECOMB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 OPENING HILL RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1789
Mailing Address - Country:US
Mailing Address - Phone:502-938-0076
Mailing Address - Fax:
Practice Address - Street 1:3074 WHITNEY AVE STE 211
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2391
Practice Address - Country:US
Practice Address - Phone:860-813-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist