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General NPI Number Information
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NPI Number | 1104997212
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Entity Type | Individual
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Provider Name | FRANK FOGAL PT
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Gender | Male
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Dates
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Enumeration Date | 11/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1524 MCHENRY AVE STE 500
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City | MODESTO
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State | CA
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Zip | 95350-4568
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Country | US
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Telephone | 209-575-5801
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Fax | 209-575-0115
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Provider Business Mailing Address
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Address Line | 2609 BEATRICE LN
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City | MODESTO
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State | CA
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Zip | 95355-9369
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Country | US
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Telephone | 209-551-3820
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 21525
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License Number State | CA
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