Provider Demographics
NPI:1831128107
Name:EDWARDS, ALBERT MAITLAND
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:MAITLAND
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-1121
Mailing Address - Country:US
Mailing Address - Phone:352-732-2273
Mailing Address - Fax:352-732-2280
Practice Address - Street 1:1852 NE 39TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34479-8643
Practice Address - Country:US
Practice Address - Phone:352-732-2273
Practice Address - Fax:352-732-2280
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8534Medicare ID - Type UnspecifiedPHYSICAL THERAPY