Provider Demographics
NPI:1548789480
Name:EDMUNDS, CURTIS EBRAY JR (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:EBRAY
Last Name:EDMUNDS
Suffix:JR
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
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Mailing Address - Street 1:1718 PINE COVE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2714 HENNING DR STE 1
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4502
Practice Address - Country:US
Practice Address - Phone:434-429-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC16006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist