Provider Demographics
NPI:1770732075
Name:EDWARDS, CALEB PAXTON (PT)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:PAXTON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-5585
Mailing Address - Country:US
Mailing Address - Phone:479-524-3378
Mailing Address - Fax:479-524-3370
Practice Address - Street 1:2021-B E MAIN STREET
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761
Practice Address - Country:US
Practice Address - Phone:479-524-3378
Practice Address - Fax:479-524-3370
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist