Provider Demographics
NPI:1457088114
Name:E D W ENTERPRISES INC
Entity Type:Organization
Organization Name:E D W ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:318-417-0108
Mailing Address - Street 1:3700 OLD SHED RD STE 7
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2820
Mailing Address - Country:US
Mailing Address - Phone:318-417-0108
Mailing Address - Fax:
Practice Address - Street 1:3700 OLD SHED RD STE 7
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2820
Practice Address - Country:US
Practice Address - Phone:318-417-0108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy