Provider Demographics
NPI:1154722650
Name:DEAN M EDWARDS DPT INC
Entity type:Organization
Organization Name:DEAN M EDWARDS DPT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:MARK ANTHONY
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPT
Authorized Official - Phone:914-320-3233
Mailing Address - Street 1:2350 NAUTICAL WAY
Mailing Address - Street 2:APT 114
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1257
Mailing Address - Country:US
Mailing Address - Phone:914-320-3233
Mailing Address - Fax:
Practice Address - Street 1:782 SILVER CLOUD CIR
Practice Address - Street 2:# 204
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1535
Practice Address - Country:US
Practice Address - Phone:914-320-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty