Provider Demographics
NPI:1740728435
Name:EDWARDS, MICHAEL S (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 POST RD
Mailing Address - Street 2:SUITE 114 PMB 362
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-712-3172
Mailing Address - Fax:
Practice Address - Street 1:69 BURLINGAME RD
Practice Address - Street 2:GOLF ACADEMY WITH TODD CAMPBELL
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921
Practice Address - Country:US
Practice Address - Phone:401-864-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16901225100000X
RIPT03472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist