Provider Demographics
NPI:1861422255
Name:EDWARDS, BILLY TYLER JR (ATC)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:TYLER
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:ATC
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Mailing Address - Street 1:1451 CROSS WINDS AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4715
Mailing Address - Country:US
Mailing Address - Phone:270-843-1063
Mailing Address - Fax:270-745-5333
Practice Address - Street 1:1605 AVENUE OF CHAMPIONS
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-6412
Practice Address - Country:US
Practice Address - Phone:270-745-6026
Practice Address - Fax:270-745-5333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT0162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer