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General NPI Number Information
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NPI Number | 1003545633
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Entity Type | Individual
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Provider Name | MADISON GRACE FORREN ATC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 16 WOODBINE LN
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City | DANVILLE
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State | PA
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Zip | 17821-8029
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Country | US
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Telephone | 800-275-6401
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Fax |
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Provider Business Mailing Address
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Address Line | 7 RUNYAN RD
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City | SELINSGROVE
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State | PA
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Zip | 17870-8386
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Country | US
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Telephone | 470-248-0157
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | PA
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