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General NPI Number Information
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NPI Number | 1003449489
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Entity Type | Individual
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Provider Name | JOHN LORENZ LOYOLA MANUBAG PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 3900 SULLIVAN DR
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City | SWANSEA
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State | IL
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Zip | 62226-7397
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Country | US
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Telephone | 618-234-8910
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Fax | 618-234-8920
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Provider Business Mailing Address
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Address Line | 124 KENNETH DR APT C
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City | TROY
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State | IL
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Zip | 62294-1742
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Country | US
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Telephone | 859-408-5775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.024932
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License Number State | IL
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