Provider Demographics
NPI:1871020768
Name:EDWARDS, PHILLIP ANDREW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANDREW
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 W BEWICK ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3030
Mailing Address - Country:US
Mailing Address - Phone:682-553-1913
Mailing Address - Fax:
Practice Address - Street 1:9628 BARTLETT CIR STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4447
Practice Address - Country:US
Practice Address - Phone:817-862-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1290802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist