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General NPI Number Information
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NPI Number | 1093615809
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Entity Type | Individual
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Provider Name | JEDD BEROS
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Gender | Male
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 3051 VINTAGE BOULEVARD 3RD FLOOR- PHYSICAL REHABILITATION
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City | JUNEAU
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State | AK
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Zip | 99801
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Country | US
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Telephone | 907-463-0140
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Fax | 907-463-0141
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Provider Business Mailing Address
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Address Line | 3100 CHANNEL DR STE 300
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City | JUNEAU
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State | AK
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Zip | 99801-7837
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Country | US
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Telephone |
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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