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General NPI Number Information
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NPI Number | 1194108761
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Entity Type | Organization
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Legal Business Name | COG RESTORE, LLC
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 9053 ESTATE THOMAS ROYAL PALM PROFESSIONAL BUILDING, STE 206
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City | ST THOMAS
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State | VI
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Zip | 00802
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Country | US
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Telephone | 340-779-9355
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11567
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City | ST THOMAS
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State | VI
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Zip | 00801-4567
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Country | US
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Telephone | 340-779-9355
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN CARLOS BACOT
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Credential | MD
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Telephone | 340-779-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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