Individual
RICHARD EDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2612 W 9545 S, SOUTH JORDAN, UT 84095-9466
(801) 254-1693
Mailing address
2612 W 9545 S, SOUTH JORDAN, UT 84095-9466
(801) 254-1693
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
110002-2401
UT
Other
Enumeration date
04/03/2007
Last updated
07/08/2007
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