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Individual
JOHN EDDY
Active
Individual
JOHN EDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT003101L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001604400-0003
DPW
PA
01
—
90955
HIGHMARK
PA
Enumeration date
01/23/2007
Last updated
08/24/2007
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