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General NPI Number Information
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NPI Number | 1104309095
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Entity Type | Organization
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Legal Business Name | HYBRID THERAPY SERVICES LLC
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 1505 DELASHMUT AVE
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City | COLUMBUS
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State | OH
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Zip | 43212-2641
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Country | US
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Telephone | 740-816-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 6636 HEATHERSTONE CIR
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City | DUBLIN
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State | OH
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Zip | 43017-5235
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Country | US
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Telephone | 740-816-0155
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEVEE SRESTHADATTA
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Credential | DPT
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Telephone | 740-816-0155
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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 | 014066
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License Number State | OH
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