Provider Demographics
NPI:1528209301
Name:EDWARDS, REBECCA LYNN (LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 GOVERNOR MANLY WAY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8599
Mailing Address - Country:US
Mailing Address - Phone:919-562-9410
Mailing Address - Fax:
Practice Address - Street 1:11200 GOVERNOR MANLY WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8599
Practice Address - Country:US
Practice Address - Phone:919-562-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer