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General NPI Number Information
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NPI Number | 1023314853
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Entity Type | Individual
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Provider Name | WENDY WILSON
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Gender | Female
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 1601 S MAIN ST
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City | ROSWELL
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State | NM
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Zip | 88203-5436
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Country | US
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Telephone | 575-623-6008
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Fax |
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Provider Business Mailing Address
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Address Line | 5625 N RED OAK DR
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City | GREENFIELD
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State | IN
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Zip | 46140-8757
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Country | US
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Telephone | 765-524-2407
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06001423A
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License Number State | IN
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