Provider Demographics
NPI:1669932141
Name:EDMISTON PHYSICAL THERAPY CO
Entity type:Organization
Organization Name:EDMISTON PHYSICAL THERAPY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMISTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:814-934-0338
Mailing Address - Street 1:5136 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1120
Mailing Address - Country:US
Mailing Address - Phone:814-934-0338
Mailing Address - Fax:
Practice Address - Street 1:2927 BEALE AVE. SUITE E101
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601
Practice Address - Country:US
Practice Address - Phone:814-934-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty