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General NPI Number Information
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NPI Number | 1174982425
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Entity Type | Individual
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Provider Name | MICHAEL S STOUT DPT
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Gender | Male
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 300 W WATER ST
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City | TOMS RIVER
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State | NJ
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Zip | 08753-6692
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Country | US
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Telephone | 732-703-7988
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Fax |
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Provider Business Mailing Address
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Address Line | 522 W PESTALOZZI AVE
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City | EGG HARBOR CITY
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State | NJ
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Zip | 08215-3320
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Country | US
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Telephone | 609-214-7522
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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 | 2251C2600X
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Taxonomy Name | Cardiopulmonary Physical Therapist
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License Number | 40QA01513200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01513200
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License Number State | NJ
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