Provider Demographics
NPI:1538286034
Name:EDWARDS, JAMES RUSSELL (PT, MPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RUSSELL
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PT, MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:5432 SOUTH FORTY DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348
Mailing Address - Country:US
Mailing Address - Phone:910-223-0738
Mailing Address - Fax:
Practice Address - Street 1:4101 RAEFORD RD UNIT 100B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4126
Practice Address - Country:US
Practice Address - Phone:910-908-2222
Practice Address - Fax:910-482-5070
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist