Provider Demographics
NPI:1598025074
Name:EDWARDS, KEENA NATASHIA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KEENA
Middle Name:NATASHIA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:5009 RIVER CHASE DR
Practice Address - Street 2:STE 100C
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7484
Practice Address - Country:US
Practice Address - Phone:334-298-0650
Practice Address - Fax:334-298-1020
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA6225225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL636000526OtherEAST ALABAMA MEDICAL CENTER