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General NPI Number Information
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NPI Number | 1174520910
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Entity Type | Organization
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Legal Business Name | ADVANCED REHABILITATION MEDICAL SERVICES
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4265 LAURA ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2836
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Country | US
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Telephone | 941-764-7117
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Fax | 941-764-1049
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Provider Business Mailing Address
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Address Line | PO BOX 510816
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City | PUNTA GORDA
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State | FL
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Zip | 33951-0816
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Country | US
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Telephone | 941-764-7117
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Fax | 941-764-1049
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEITH ANTHONY WILLIAMS
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Credential | M.D.
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Telephone | 941-764-7117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME0066000
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License Number State | FL
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