Provider Demographics
NPI:1639574288
Name:EDWARDS, CHARLES WARREN (PT, ATC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WARREN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:73 OLD DUBLIN PIKE
Practice Address - Street 2:SUITE 6
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2491
Practice Address - Country:US
Practice Address - Phone:214-489-1701
Practice Address - Fax:215-489-1705
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209845225100000X
PAPT024958225100000X
NY0026102255A2300X
PART0057952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer