Provider Demographics
NPI:1548653496
Name:EDEN, MICHAEL S JR (MS, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:EDEN
Suffix:JR
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S DEERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7784
Mailing Address - Country:US
Mailing Address - Phone:704-224-4955
Mailing Address - Fax:
Practice Address - Street 1:2300 W INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2441
Practice Address - Country:US
Practice Address - Phone:704-637-4780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer