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General NPI Number Information
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NPI Number | 1194128710
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Entity Type | Organization
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Legal Business Name | WESTERN PHYSIATRY, PC
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Dates
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Enumeration Date | 09/28/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 1921 W HOSPITAL DR
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City | TUCSON
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State | AZ
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Zip | 85704-7806
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Country | US
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Telephone | 520-742-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 658 W TREMOLO LN
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City | ORO VALLEY
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State | AZ
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Zip | 85737-3771
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Country | US
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Telephone | 520-471-3764
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Fax | 520-329-8650
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JEFFREY WICK
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Credential | MD
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Telephone | 520-471-3764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 26973
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License Number State | AZ
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