Provider Demographics
NPI:1760633853
Name:EDWARDS, BRIAN P (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:P
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1814
Mailing Address - Country:US
Mailing Address - Phone:702-419-5666
Mailing Address - Fax:775-324-2029
Practice Address - Street 1:910 WAINEE ST
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1622
Practice Address - Country:US
Practice Address - Phone:808-432-5842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2847225100000X
NV1437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist