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General NPI Number Information
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NPI Number | 1043659063
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Entity Type | Individual
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Provider Name | SAMANTHA LARSON ANELLO DPT
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Gender | Female
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Dates
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Enumeration Date | 06/24/2013
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 3316 3RD ST S SUITE 104
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-6073
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Country | US
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Telephone | 904-685-8109
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Fax | 904-249-0907
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Provider Business Mailing Address
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Address Line | 1763 SUNSET DR
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-2983
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Country | US
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Telephone | 904-859-2978
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT27903
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License Number State | FL
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