Individual
MRS. KIMBERLY ROSE EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
2234 W HOUSTON ST STE B, BROKEN ARROW, OK 74012-3519
(918) 259-1888
(918) 251-3725
Mailing address
409 DAISY DR, STE F-2, TAHLEQUAH, OK 74464-7410
(918) 458-9235
(918) 458-9236
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5094
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OK
Enumeration date
09/08/2008
Last updated
06/27/2016
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