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General NPI Number Information
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NPI Number | 1225592579
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Entity Type | Organization
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Legal Business Name | LYFE N MOTION PT LLC
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 3827 SPENCER ST
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City | HARVEY
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State | LA
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Zip | 70058-5910
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Country | US
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Telephone | 504-628-6394
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Fax |
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Provider Business Mailing Address
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Address Line | 3857 IRWIN KUNTZ DR
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City | HARVEY
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State | LA
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Zip | 70058-2128
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Country | US
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Telephone | 504-628-6394
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MIAPATRICE BURROWS-ALLEN
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Credential |
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Telephone | 504-628-6394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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