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General NPI Number Information
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NPI Number | 1245870757
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Entity Type | Organization
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Legal Business Name | BALANCED PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 2879 MAJESTIC OAKS LN
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-8324
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Country | US
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Telephone | 904-465-2934
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Fax | 904-204-0934
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Provider Business Mailing Address
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Address Line | 2879 MAJESTIC OAKS LN
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-8324
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Country | US
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Telephone | 904-465-2934
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Fax | 904-204-0934
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Authorized Official
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Title or Position | OWNER
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Name | BRANDY WEFLEN
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Credential | D.P.T
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Telephone | 904-465-2934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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