Provider Demographics
NPI:1790003135
Name:EDGE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:EDGE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-865-7998
Mailing Address - Street 1:244 GLEN COVE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-4171
Mailing Address - Country:US
Mailing Address - Phone:516-865-7998
Mailing Address - Fax:
Practice Address - Street 1:244 GLEN COVE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-4171
Practice Address - Country:US
Practice Address - Phone:516-865-7998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty