Provider Demographics
NPI:1811959117
Name:EDWARDS, HENRY T (MED, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:T
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:296 BAXLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-6766
Mailing Address - Country:US
Mailing Address - Phone:910-865-3909
Mailing Address - Fax:
Practice Address - Street 1:4895 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2162
Practice Address - Country:US
Practice Address - Phone:910-737-3181
Practice Address - Fax:910-739-4027
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer