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General NPI Number Information
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NPI Number | 1164186342
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Entity Type | Individual
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Provider Name | MATTHEW KIRKPATRICK
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Gender | Male
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 1776 REVOLUTION WAY
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City | FOXBOROUGH
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State | MA
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Zip | 02035-1157
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Country | US
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Telephone | 508-734-0794
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Fax |
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Provider Business Mailing Address
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Address Line | 230 STONEHAVEN DR
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City | RED HILL
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State | PA
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Zip | 18076-1412
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT005954
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2990
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00207500
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License Number State | NJ
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