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General NPI Number Information
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NPI Number | 1215204995
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Entity Type | Individual
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Provider Name | BENJAMIN ROBERT HOLMSTEDT PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 900 LINCOLN AVE
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City | GRANT
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State | NE
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Zip | 69140-3095
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Country | US
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Telephone | 308-289-4290
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Fax |
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Provider Business Mailing Address
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Address Line | 2207 WESTRIDGE DR
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City | OGALLALA
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State | NE
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Zip | 69153-3213
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Country | US
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Telephone | 308-289-4290
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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 | 2743
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License Number State | NE
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