Provider Demographics
NPI:1184755936
Name:ROBERTS, EDGAR CORRIGAN (PT)
Entity type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:CORRIGAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MCQUISTON RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-6827
Mailing Address - Country:US
Mailing Address - Phone:901-837-8973
Mailing Address - Fax:
Practice Address - Street 1:1992 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3623
Practice Address - Country:US
Practice Address - Phone:901-476-1820
Practice Address - Fax:901-476-0863
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT00000000798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist