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General NPI Number Information
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NPI Number | 1053854711
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Entity Type | Organization
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Legal Business Name | PHYST
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 02/10/2019
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Provider Practice Location Address
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Address Line | 5447 SHADY PINE ST S
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City | JACKSONVILLE
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State | FL
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Zip | 32244-8543
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Country | US
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Telephone | 318-272-2044
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Fax |
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Provider Business Mailing Address
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Address Line | 5447 SHADY PINE ST S
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City | JACKSONVILLE
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State | FL
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Zip | 32244-8543
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Country | US
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Telephone | 904-613-1195
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Fax | 904-559-1688
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Authorized Official
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Title or Position | OWNER/DOCTOR OF PHYSICAL THERAPY
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Name | DR. CHAYLA CREER
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Credential | DPT
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Telephone | 904-613-1195
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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 | PT29037
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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