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General NPI Number Information
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NPI Number | 1063858470
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Entity Type | Organization
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Legal Business Name | FLOURISH PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 05/13/2013
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 95 MONTGOMERY DR SUITE 90
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City | SANTA ROSA
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State | CA
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Zip | 95404-6630
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Country | US
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Telephone | 707-968-7378
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Fax |
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Provider Business Mailing Address
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Address Line | 95 MONTGOMERY DR SUITE 90
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City | SANTA ROSA
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State | CA
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Zip | 95404-6630
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DUSTIENNE MILLER
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Credential | PT, MS, WCS
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Telephone | 707-968-7378
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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 | 39830
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License Number State | CA
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