Provider Demographics
NPI:1023284528
Name:EDWARDS, JEFFREY DAVID (MSPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DAVID
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N 85TH ST
Mailing Address - Street 2:REAL REHAB PHYSICAL THERAPY
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3721
Mailing Address - Country:US
Mailing Address - Phone:206-706-7500
Mailing Address - Fax:206-706-7890
Practice Address - Street 1:514 N 85TH ST
Practice Address - Street 2:REAL REHAB PHYSICAL THERAPY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3721
Practice Address - Country:US
Practice Address - Phone:206-706-7500
Practice Address - Fax:206-706-7890
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60016485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist