Provider Demographics
NPI:1649495102
Name:EDWARDS, AMY M (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
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:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853-0079
Mailing Address - Country:US
Mailing Address - Phone:419-233-4173
Mailing Address - Fax:419-532-2512
Practice Address - Street 1:2758 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2120
Practice Address - Country:US
Practice Address - Phone:419-228-7871
Practice Address - Fax:419-228-7872
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT7638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHED4211751Medicare PIN