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General NPI Number Information
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NPI Number | 1124474135
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL PERFORMANCE
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 12630 ROCKROSE GLN
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2829
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Country | US
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Telephone | 301-904-2343
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Fax |
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Provider Business Mailing Address
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Address Line | 12630 ROCKROSE GLN
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2829
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Country | US
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Telephone | 301-904-2343
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ADAM CECIL
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Credential |
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Telephone | 571-338-7002
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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 | L16000080985
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License Number State | FL
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