Provider Demographics
NPI:1669221461
Name:EDMUNDSON, DAVID TAYLOR (CEP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:TAYLOR
Last Name:EDMUNDSON
Suffix:
Gender:M
Credentials:CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 BRIDGES ST EXT STE 101
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-8978
Mailing Address - Country:US
Mailing Address - Phone:252-648-8010
Mailing Address - Fax:252-917-8441
Practice Address - Street 1:4913 BRIDGES ST EXT STE 101
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-8978
Practice Address - Country:US
Practice Address - Phone:252-648-8010
Practice Address - Fax:252-917-8441
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1074113224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist