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General NPI Number Information
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NPI Number | 1124374798
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Entity Type | Organization
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Legal Business Name | REHOBOTH PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 01/09/2013
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Provider Practice Location Address
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Address Line | 598 NEW YORK AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-1507
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Country | US
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Telephone | 347-221-1646
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Fax | 718-481-7929
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Provider Business Mailing Address
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Address Line | 24104 148TH RD
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City | ROSEDALE
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State | NY
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Zip | 11422-3249
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Country | US
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Telephone | 347-221-1646
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Fax | 718-481-7929
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. ADEDOLAPO ADESHOLA OLURINDE
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Credential | DPT
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Telephone | 347-351-4970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 023029
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License Number State | NY
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