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General NPI Number Information
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NPI Number | 1043267289
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Entity Type | Organization
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Legal Business Name | REPLAY PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2122 S DIXON RD SUITE 250
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City | KOKOMO
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State | IN
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Zip | 46902-6409
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Country | US
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Telephone | 765-455-2122
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Fax | 765-455-3122
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Provider Business Mailing Address
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Address Line | 2122 S DIXON RD SUITE 250
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City | KOKOMO
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State | IN
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Zip | 46902-6409
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Country | US
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Telephone | 765-455-2122
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Fax | 765-455-3122
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Authorized Official
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Title or Position | ATHLETIC TRAINER
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Name | MR. JEFFREY ALLYN MOSSBURG
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Credential | M.S., A.T.C.
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Telephone | 765-455-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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