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General NPI Number Information
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NPI Number | 1093163081
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Entity Type | Individual
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Provider Name | MICAH KUST
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Gender | Male
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 2544 E SUNRISE BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3228
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Country | US
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Telephone | 954-253-0853
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Fax | 954-416-3625
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Provider Business Mailing Address
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Address Line | 2544 E SUNRISE BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3228
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Country | US
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Telephone | 954-253-0853
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Fax | 954-416-3625
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13416
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 31513
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License Number State | FL
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