Provider Demographics
NPI:1831257476
Name:EDGERLY, BRIAN CHARLES (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CHARLES
Last Name:EDGERLY
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 1:666 PLAINSBORO RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3030
Mailing Address - Country:US
Mailing Address - Phone:609-275-0666
Mailing Address - Fax:609-275-8004
Practice Address - Street 1:666 PLAINSBORO RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3030
Practice Address - Country:US
Practice Address - Phone:609-275-0666
Practice Address - Fax:609-275-8004
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00527200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ113971OtherAETNA
NJ071243RWSMedicare ID - Type Unspecified