Provider Demographics
NPI:1750350328
Name:EDWARDS, DENISE (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
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 1:5951 FAIRINGTON FARMS LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1545
Mailing Address - Country:US
Mailing Address - Phone:770-879-5646
Mailing Address - Fax:770-981-2024
Practice Address - Street 1:5295 STONE MOUNTAIN HWY
Practice Address - Street 2:SUITE I
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6416
Practice Address - Country:US
Practice Address - Phone:770-879-5646
Practice Address - Fax:770-981-2024
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist