Provider Demographics
NPI:1811485261
Name:EDMOND, AMBER MARIE (KT, RYT)
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:MARIE
Last Name:EDMOND
Suffix:
Gender:F
Credentials:KT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 MYRTA DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9648
Mailing Address - Country:US
Mailing Address - Phone:330-749-9615
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1866226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1866OtherCOUNCIL ON PROFESSIONAL STANDARDS FOR KINESIOTHERAPY
OH236845OtherYOGA ALLIANCE