Provider Demographics
NPI:1053900662
Name:EDWARDS, ELI KRUG (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:KRUG
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 S PLATTE RIVER DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-4015
Mailing Address - Country:US
Mailing Address - Phone:720-248-4386
Mailing Address - Fax:
Practice Address - Street 1:2101 S PLATTE RIVER DR UNIT A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-4015
Practice Address - Country:US
Practice Address - Phone:720-248-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist