Individual
JANE EDMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
855 SAM NEWELL RD STE 201, MATTHEWS, NC 28105-7594
(704) 814-4479
Mailing address
7013 W DUNCAN RD, INDIAN TRAIL, NC 28079-8742
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1746
LICENSE #
NC
Enumeration date
08/25/2006
Last updated
07/08/2007
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