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General NPI Number Information
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NPI Number | 1174910145
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Entity Type | Organization
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Legal Business Name | PINE RIVER PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 480 WOLVERINE DR STE 5
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City | BAYFIELD
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State | CO
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Zip | 81122-9653
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Country | US
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Telephone | 970-884-2956
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Fax |
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Provider Business Mailing Address
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Address Line | 480 WOLVERINE DR STE 5
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City | BAYFIELD
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State | CO
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Zip | 81122-9653
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Country | US
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Telephone | 970-884-2956
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Fax | 844-269-9483
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DONALD MOONEY
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Credential |
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Telephone | 970-903-8895
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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 |
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License Number State |
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