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General NPI Number Information
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NPI Number | 1225338817
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Entity Type | Organization
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Legal Business Name | PRACTICE REHABILITATION CENTER
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 13903 NW 67TH AVE 330
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City | HIALEAH
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State | FL
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Zip | 33014-2900
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Country | US
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Telephone | 305-825-8819
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Fax |
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Provider Business Mailing Address
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Address Line | 13903 NW 67TH AVE 330
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City | HIALEAH
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State | FL
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Zip | 33014-2900
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Country | US
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Telephone | 305-825-8819
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LUIS S PILETA
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Credential | MASSAGE THERAPIST
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Telephone | 305-825-8818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MM25692
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License Number State | FL
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