Provider Demographics
NPI:1902227200
Name:EDGE PHYSICAL THERAPY PSC
Entity Type:Organization
Organization Name:EDGE PHYSICAL THERAPY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:270-824-9295
Mailing Address - Street 1:100 YMCA DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9000
Mailing Address - Country:US
Mailing Address - Phone:270-824-9227
Mailing Address - Fax:270-824-9206
Practice Address - Street 1:100 YMCA DR
Practice Address - Street 2:SUITE 5
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9000
Practice Address - Country:US
Practice Address - Phone:270-824-9227
Practice Address - Fax:270-824-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty