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General NPI Number Information
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NPI Number | 1104816057
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Entity Type | Organization
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Legal Business Name | FINISHLINE PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 969 S SANTA FE AVE STE E2
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City | VISTA
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State | CA
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Zip | 92083-6910
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Country | US
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Telephone | 760-330-9995
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Fax |
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Provider Business Mailing Address
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Address Line | 969 S SANTA FE AVE STE E2
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City | VISTA
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State | CA
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Zip | 92083-6910
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Country | US
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Telephone | 760-330-9995
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. GARY RAYMOND
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Credential | P.T
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Telephone | 323-465-9180
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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 |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT22017
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License Number State | CA
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