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General NPI Number Information
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NPI Number | 1073086914
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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 | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 415 E COOK RD STE 600
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City | FORT WAYNE
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State | IN
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Zip | 46825-3657
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Country | US
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Telephone | 260-438-4273
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Fax |
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Provider Business Mailing Address
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Address Line | 415 E COOK RD STE 600
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City | FORT WAYNE
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State | IN
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Zip | 46825-3657
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Country | US
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Telephone | 260-438-4273
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHAD PARENT
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Credential | PT
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Telephone | 260-438-4273
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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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