Provider Demographics
NPI:1144508169
Name:DI EDWARDO, YVONNE HUBERTINA (PT)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:HUBERTINA
Last Name:DI EDWARDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEAN GALLO CT
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3446
Mailing Address - Country:US
Mailing Address - Phone:973-359-1229
Mailing Address - Fax:
Practice Address - Street 1:99 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1634
Practice Address - Country:US
Practice Address - Phone:973-889-5382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA004084002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00408400OtherNEW JERSEY BOARD OF PHYSICAL THERAPY