Provider Demographics
NPI:1609190545
Name:EDWARDS, JAMES RODNEY (PTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RODNEY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:ROD
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:140 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-4916
Mailing Address - Country:US
Mailing Address - Phone:606-271-6241
Mailing Address - Fax:
Practice Address - Street 1:140 HARRIS RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-4916
Practice Address - Country:US
Practice Address - Phone:606-271-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02524314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility