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General NPI Number Information
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NPI Number | 1235568478
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Entity Type | Individual
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Provider Name | WILLIAM LIVERSEDGE
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Gender | Male
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 1431 SW 1ST AVE
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City | OCALA
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State | FL
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Zip | 34471-6500
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Country | US
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Telephone | 352-401-1175
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Fax |
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Provider Business Mailing Address
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Address Line | 6843 SW 108TH ST
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City | OCALA
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State | FL
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Zip | 34476-4758
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 23182
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License Number State | FL
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