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General NPI Number Information
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NPI Number | 1205615994
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Entity Type | Individual
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Provider Name | JASON SCOTT HAER PT
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Gender | Male
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 409 W SOUTH HILLS DR
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City | MARYVILLE
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State | MO
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Zip | 64468-3639
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Country | US
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Telephone | 660-562-7830
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Fax |
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Provider Business Mailing Address
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Address Line | 27276 CEDAR RIDGE DR
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City | MARYVILLE
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State | MO
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Zip | 64468-9487
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 109750
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License Number State | MO
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