Individual
MR. JERRY LYNN EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
45390 GREEN AVE, CALLAHAN, FL 32011-3711
(904) 879-1223
(904) 277-4177
Mailing address
45390 GREEN AVE, CALLAHAN, FL 32011-3711
(904) 879-1223
(904) 277-4177
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA23801
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA23801
STATE OF FLORIDA
FL
Enumeration date
11/21/2012
Last updated
11/21/2012
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