Provider Demographics
NPI:1770852006
Name:EDGE REHABILITATION & WELLNESS LLC
Entity Type:Organization
Organization Name:EDGE REHABILITATION & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:719-433-0496
Mailing Address - Street 1:2150 HOLLOW BROOK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8413
Mailing Address - Country:US
Mailing Address - Phone:719-599-5330
Mailing Address - Fax:719-599-5438
Practice Address - Street 1:2150 HOLLOW BROOK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8413
Practice Address - Country:US
Practice Address - Phone:719-599-5330
Practice Address - Fax:719-599-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty