Provider Demographics
NPI:1821214354
Name:MURPHY, EDITH LEIGHTON (PT)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:LEIGHTON
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1372
Mailing Address - Country:US
Mailing Address - Phone:510-451-5560
Mailing Address - Fax:510-451-5564
Practice Address - Street 1:373 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1372
Practice Address - Country:US
Practice Address - Phone:510-451-5560
Practice Address - Fax:510-451-5564
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT103972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ36501ZOtherBLUE SHIELD PROVIDER #