Provider Demographics
NPI:1700198207
Name:STARTT, EDWARD KENLY (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:KENLY
Last Name:STARTT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2682
Mailing Address - Street 2:29745 DUSTIN AVE
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8950
Mailing Address - Country:US
Mailing Address - Phone:443-260-2660
Mailing Address - Fax:443-260-2754
Practice Address - Street 1:314 FRANKLIN AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1215
Practice Address - Country:US
Practice Address - Phone:410-641-0999
Practice Address - Fax:410-641-9576
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD16913225100000X
COPTL-10393225100000X
DEJ1-0002589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16913Other1700198207