Provider Demographics
NPI:1710956420
Name:EDENS, NICOLE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:EDENS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3642
Mailing Address - Country:US
Mailing Address - Phone:318-388-1303
Mailing Address - Fax:318-388-1707
Practice Address - Street 1:2115 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3642
Practice Address - Country:US
Practice Address - Phone:318-388-1303
Practice Address - Fax:318-388-1707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA041422251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics