Individual provider Active NPI

Charlie Edwards, DPT

  • Physical Therapist
  • Twin Falls, ID
National Provider Identifier
1891112132
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT3533 Issued in ID
Practice address
254 River Vista PL
Twin Falls, ID 83301-3006
Phone
(208) 734-7333
Fax
(208) 734-8350
NPI assigned
Mar 25, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT3533 ID Primary

Addresses

Primary practice location

254 River Vista PL
Twin Falls, ID 83301-3006

Mailing address

254 River Vista PL
Twin Falls, ID 83301-3006
Phone (208) 734-7333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231208001405 UT Practitioner - Physical Therapist in Private Practice 2264665579 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT3533IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Oct 28, 2023 Accepting new patients
Ihc Health Services Inc Physical Therapist CurrentSince Oct 28, 2023 Accepting new patients

Locations

1400 N 500 E
North Logan, UT 84341
Phone (435) 716-1000

5171 S Cottonwood St
Ste 900
Salt Lake City, UT 84107
Phone (801) 507-2050

905 N 1000 W
Tremonton, UT 84337
Phone (435) 207-4500

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1891112132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254 RIVER VISTA PL",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013006",
            "telephone_number": "208-734-7333",
            "fax_number": "208-734-8350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 RIVER VISTA PL",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013006",
            "telephone_number": "208-734-7333",
            "fax_number": "208-734-8350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "CHARLIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-25",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT3533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.