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General NPI Number Information
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NPI Number | 1093141160
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL THERAPEUTIC CARE CENTER,LLC
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 4947 N PALMETTO AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-7116
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Country | US
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Telephone | 407-629-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 4947 N PALMETTO AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-7116
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Country | US
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Telephone | 407-629-4325
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MARIEL L TORRES
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Credential | AP
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Telephone | 407-629-4325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AP 3229
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License Number State | FL
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