Provider Demographics
NPI:1952653644
Name:EDGECOMB, MISTY (LMT)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:EDGECOMB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4742
Mailing Address - Country:US
Mailing Address - Phone:207-240-6415
Mailing Address - Fax:
Practice Address - Street 1:185 WEBSTER ST STE 14A
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5500
Practice Address - Country:US
Practice Address - Phone:207-240-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2161225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist