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General NPI Number Information
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NPI Number | 1083157978
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Entity Type | Individual
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Provider Name | CIMONE BLSCK
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Gender | Female
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 710 W LAKE ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2916
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Country | US
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Telephone | 612-450-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 9101 OLD CEDAR AVE S APT 207
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City | MINNEAPOLIS
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State | MN
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Zip | 55425-2345
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Country | US
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Telephone | 612-986-2520
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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