Provider Demographics
NPI:1578159539
Name:EDWARDS, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 WINDING OAKS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-6865
Mailing Address - Country:US
Mailing Address - Phone:301-712-5017
Mailing Address - Fax:
Practice Address - Street 1:1419 KNECHT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1415
Practice Address - Country:US
Practice Address - Phone:410-247-9595
Practice Address - Fax:410-247-7553
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD28452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program