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General NPI Number Information
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NPI Number | 1245784230
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Entity Type | Individual
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Provider Name | SHANNON SAMLUK
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Gender | Female
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 06/18/2017
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Provider Practice Location Address
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Address Line | 1755 WITTINGTON PLACE STE. #175 DELTA HEALTHCARE PROVIDERS
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City | FLOWER MOUND
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State | TX
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Zip | 75234
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Country | US
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Telephone | 866-221-5405
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Fax |
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Provider Business Mailing Address
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Address Line | 13609 CALIFORNIA STREET SUITE 200
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City | OMAHA
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State | NE
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Zip | 68154
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Country | US
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Telephone | 800-456-5857
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1279436
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License Number State | TX
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