Provider Demographics
NPI:1700415171
Name:EDWARDS, CHARLES H (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 OLD FORESTER DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4045
Mailing Address - Country:US
Mailing Address - Phone:816-294-3070
Mailing Address - Fax:
Practice Address - Street 1:224 SOUTH WOODS MILLRD.
Practice Address - Street 2:SUITE 610 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-205-6551
Practice Address - Fax:314-576-2371
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist