Basic Information
| Provider Information | |||||||||
| NPI: | 1962614289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDSON | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | STONE | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4326 BIG SPRING GAP RD | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373677654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238813139 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 MAPLE GROVE DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CROSSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385557650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314566608 | ||||||||
| FaxNumber: | 9314566673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT0000005218 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.