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General NPI Number Information
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NPI Number | 1093177297
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Entity Type | Organization
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Legal Business Name | ROOT PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/26/2016
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Last Update Date | 03/26/2016
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Provider Practice Location Address
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Address Line | 17307 E BACA DR
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-2664
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Country | US
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Telephone | 816-651-9687
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Fax |
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Provider Business Mailing Address
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Address Line | 17307 E BACA DR
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-2664
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Country | US
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Telephone | 816-651-9687
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JENNIFER LEIGH ANDERSON
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Credential | PT, DPT
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Telephone | 816-651-9687
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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 | AZ
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