Individual
MRS. KELLY EDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT, PT
Contact information
Practice address
1451 NEWTON DR, TIFTON, GA 31794-3752
(229) 382-1665
Mailing address
642 BELFLOWER RD, TIFTON, GA 31794-2020
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT009867
GA
Other
Enumeration date
06/14/2019
Last updated
06/14/2019
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