Provider Demographics
NPI:1598247728
Name:EDGE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:EDGE PHYSICAL THERAPY LLC
Other - Org Name:EDGE PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PT/OWNER AND OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:GENEE
Authorized Official - Last Name:TIPTON-GERPHEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-361-3847
Mailing Address - Street 1:920 CAMAS PL
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-8644
Mailing Address - Country:US
Mailing Address - Phone:509-361-3847
Mailing Address - Fax:
Practice Address - Street 1:920 CAMAS PL
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-8644
Practice Address - Country:US
Practice Address - Phone:509-361-3847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60108038261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy