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General NPI Number Information
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NPI Number | 1063569358
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Entity Type | Organization
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Legal Business Name | CORE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 14540 JOHN MARSHALL HWY
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City | GAINESVILLE
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State | VA
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Zip | 20155-1691
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Country | US
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Telephone | 571-248-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 8665 SUDLEY RD # 324
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City | MANASSAS
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State | VA
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Zip | 20110-4588
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Country | US
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Telephone | 703-357-5239
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TONY N NGO
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Credential |
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Telephone | 703-357-5239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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