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General NPI Number Information
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NPI Number | 1205024858
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Entity Type | Organization
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Legal Business Name | MEDICAL AND THERAPY SERVICE INC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 4896 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33126-2102
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Country | US
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Telephone | 305-445-4704
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Fax | 305-445-4705
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Provider Business Mailing Address
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Address Line | 4896 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33126-2102
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Country | US
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Telephone | 305-445-4704
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Fax | 305-445-4705
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERTO DIAZ
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Credential |
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Telephone | 305-445-4704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | HCC7566
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License Number State | FL
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