Doctor Name: | DENEB EDWARDS |
NPI Number: | 1023489218 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.T. |
License Number: | MASG-1932 |
Business Practice Address: | 1315 Oakley Ave Burley, ID - 833181833 |
Business Phone Number: | 2082442585 |
Business Fax Number: | |
Mailing Address: | 621 Doggett Dr, HEYBURN |
State: | ID |
Postal Code: | 833369639 |
Phone Number: | 2082442585 |
Fax Number: | |
NPI Enumeration Date: | 10/13/2015 |
NPI Last Update Date: | 10/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MASG-1932 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |