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General NPI Number Information
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NPI Number | 1043849029
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Entity Type | Organization
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Legal Business Name | UR THERAPIST
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 17031 CHATSWORTH ST
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5883
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Country | US
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Telephone | 818-894-8974
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Fax |
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Provider Business Mailing Address
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Address Line | 407 AVENIDA DE JOSE
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City | REDONDO BEACH
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State | CA
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Zip | 90277-6611
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Country | US
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Telephone | 310-497-8324
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VICTOR GAJENDRAN
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Credential |
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Telephone | 310-339-0450
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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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