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General NPI Number Information
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NPI Number | 1215493614
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Entity Type | Individual
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Provider Name | JARED ANDREW ROSE DPT
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Gender | Male
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 121 N WASHINGTON
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City | AFTON
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State | WY
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Zip | 83110
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Country | US
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Telephone | 307-885-4278
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Fax | 307-885-4270
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Provider Business Mailing Address
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Address Line | 1551 RENAISSANCE TOWNE DR STE 350
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City | BOUNTIFUL
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State | UT
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Zip | 84010-7674
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Country | US
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Telephone | 801-295-3553
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Fax | 801-295-3599
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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 | 3957
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-2055
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License Number State | WY
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