Provider Demographics
NPI:1437987740
Name:EDGE PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:EDGE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:502-500-4587
Mailing Address - Street 1:530 CLAREMONT AVE UNIT 914
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-0028
Mailing Address - Country:US
Mailing Address - Phone:502-500-4587
Mailing Address - Fax:
Practice Address - Street 1:1151 COMMERCE PARKWAY
Practice Address - Street 2:SUITE E
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805
Practice Address - Country:US
Practice Address - Phone:502-500-4587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy