Shane Lee Edmondson, PT, DPT

NPI #1285272377 in Tyler, Texas

Provider Information

NPI Number: 1285272377
Entity Type: Individual
Name: Shane Lee Edmondson, PT, DPT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: PT, DPT
Enumeration Date: Dec 19, 2019
Last Updated: Dec 19, 2019

Practice Location

Address: 5407 NEW COPELAND RD STE 100
City: Tyler
State: Texas
ZIP Code: 75703-3997
Phone: (903) 630-7204

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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