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General NPI Number Information
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NPI Number | 1144222464
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Entity Type | Organization
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Legal Business Name | M & M REHAB INC
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 9401 SW HIGHWAY 200 BLDG 400 SUITE 404
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City | OCALA
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State | FL
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Zip | 34481-9612
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Country | US
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Telephone | 352-873-0925
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Fax | 352-351-3267
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Provider Business Mailing Address
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Address Line | 2300 SE 17TH ST STE 401
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City | OCALA
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State | FL
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Zip | 34471-9140
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Country | US
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Telephone | 352-351-3207
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Fax | 352-351-3267
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VICTOR BUSTAMANTE
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Credential | CPO
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Telephone | 352-331-3399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | POR89
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License Number State | FL
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