Provider Demographics
NPI:1700389145
Name:EDWARDS, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CENTER CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:56737-4040
Mailing Address - Country:US
Mailing Address - Phone:218-686-5873
Mailing Address - Fax:
Practice Address - Street 1:109 3RD ST E
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2005
Practice Address - Country:US
Practice Address - Phone:218-686-5873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist