Basic Information
| Provider Information | |||||||||
| NPI: | 1164453908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT, DPT, SCS, COMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIT 2060 | ||||||||
| Address2: | |||||||||
| City: | APO | ||||||||
| State: | AP | ||||||||
| PostalCode: | 962782060 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 51ST MEDICAL GROUP, UNIT 2060 | ||||||||
| Address2: | |||||||||
| City: | APO | ||||||||
| State: | AP | ||||||||
| PostalCode: | 962782060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157844512 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7263 | AZ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT5344 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.