Provider Demographics
NPI:1720046469
Name:EDWARDS, DODIE FEAGLEY (ATC)
Entity Type:Individual
Prefix:MRS
First Name:DODIE
Middle Name:FEAGLEY
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 24TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2628
Mailing Address - Country:US
Mailing Address - Phone:814-643-1080
Mailing Address - Fax:814-643-9231
Practice Address - Street 1:2400 CASSIDY AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652
Practice Address - Country:US
Practice Address - Phone:814-643-1080
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer