Active NPI
Joseph Kendrick Edwards, PT
- Physical Therapist
- Prosper, TX
National Provider Identifier
1376570937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1171098
- Practice address
- 1840 Stillhouse Hollow Dr
Prosper, TX 75078-8498 - Phone
- (214) 578-3278
- NPI assigned
- Jun 27, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT3230 | MS | |
| Physical Therapist | 225100000X | 04548R | LA | |
| Physical Therapist | 225100000X | 1171098 | TX | Primary |
Addresses
Primary practice location
1840 Stillhouse Hollow Dr
Prosper, TX 75078-8498
Mailing address
PO Box 314
Prosper, TX 75078-0314
Phone (214) 578-3278
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9420510 | Other | PHCS | |
| 5656762 | Other | FIRST HEALTH | |
| 00122572 | Medicaid | MS |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1171098 | TX | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Life Physical Therapy Center LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Durable Medical Equipment & Medical Supplies
- Tylertown, MS
- NPI 1952339491
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555113600000",
"number": "1376570937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 314",
"city": "PROSPER",
"state": "TX",
"postal_code": "750780314",
"telephone_number": "214-578-3278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1840 STILLHOUSE HOLLOW DR",
"city": "PROSPER",
"state": "TX",
"postal_code": "750788498",
"telephone_number": "214-578-3278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "JOSEPH",
"middle_name": "KENDRICK",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2019-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT3230",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "04548R",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1171098",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "9420510",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "5656762",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00122572",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prosper, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.