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General NPI Number Information
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NPI Number | 1235753450
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Entity Type | Individual
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Provider Name | AMANDA RAE DELCASTILLO LMT, PT, CST-D
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Gender | Female
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 2250 WILDERNESS BLVD
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City | PARRISH
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State | FL
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Zip | 34219-9431
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Country | US
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Telephone | 941-737-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 4219 NOBLE PL
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City | PARRISH
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State | FL
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Zip | 34219-7560
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA0012790
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License Number State | FL
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