Provider Demographics
NPI:1184054173
Name:EDMONDS, ELIZABETH (DPT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:PEKA
Other - Middle Name:
Other - Last Name:EDMONDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2575 N DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-1358
Mailing Address - Country:US
Mailing Address - Phone:269-342-0206
Mailing Address - Fax:269-342-6103
Practice Address - Street 1:2575 N DRAKE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-1358
Practice Address - Country:US
Practice Address - Phone:269-342-0206
Practice Address - Fax:269-342-6103
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5348826626OtherNPI