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General NPI Number Information
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NPI Number | 1265826820
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Entity Type | Organization
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Legal Business Name | J-WELL PILATES REHAB STUDIO
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Dates
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Enumeration Date | 03/22/2015
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Last Update Date | 03/22/2015
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Provider Practice Location Address
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Address Line | 310 E CALIFORNIA ST UNIT B
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9414
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Country | US
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Telephone | 541-203-0709
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Fax |
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Provider Business Mailing Address
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Address Line | 400 TETHEROW RD
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City | WILLIAMS
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State | OR
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Zip | 97544-9543
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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 | OWNER
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Name | CASSIE LEWALLEN
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Credential |
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Telephone | 307-751-1174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 6285
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License Number State | OR
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