Provider Demographics
NPI:1336340496
Name:EDWARDS, ALFRED GUY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:GUY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3527
Mailing Address - Country:US
Mailing Address - Phone:406-868-8042
Mailing Address - Fax:
Practice Address - Street 1:3511 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3527
Practice Address - Country:US
Practice Address - Phone:406-868-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3400238Medicaid
MT3400238Medicaid