Active NPI
Jerry Lynn Edwards, PTA
- Physical Therapy Assistant
- Callahan, FL
National Provider Identifier
1043554520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA23801
- Practice address
- 45390 Green Ave
Callahan, FL 32011-3711 - Phone
- (904) 879-1223
- Fax
- (904) 277-4177
- NPI assigned
- Nov 21, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA23801 | FL | Primary |
Addresses
Primary practice location
45390 Green Ave
Callahan, FL 32011-3711
Mailing address
45390 Green Ave
Callahan, FL 32011-3711
Phone (904) 879-1223
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA23801 | Other | FL | STATE OF FLORIDA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA23801 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353456000000",
"number": "1043554520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45390 GREEN AVE",
"city": "CALLAHAN",
"state": "FL",
"postal_code": "320113711",
"telephone_number": "904-879-1223",
"fax_number": "904-277-4177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45390 GREEN AVE",
"city": "CALLAHAN",
"state": "FL",
"postal_code": "320113711",
"telephone_number": "904-879-1223",
"fax_number": "904-277-4177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "JERRY",
"middle_name": "LYNN",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-11-21",
"last_updated": "2012-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA23801",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF FLORIDA",
"identifier": "PTA23801",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Callahan, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.