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General NPI Number Information
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NPI Number | 1275423972
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Entity Type | Organization
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Legal Business Name | THORACIC PARK HOLDINGS LLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1000 S WADSWORTH BLVD UNIT B
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City | LAKEWOOD
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State | CO
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Zip | 80226-4314
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Country | US
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Telephone | 720-600-0370
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Fax |
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Provider Business Mailing Address
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Address Line | 11169 E I25 FRONTAGE RD STE C
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City | FIRESTONE
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State | CO
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Zip | 80504-5211
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Country | US
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Telephone | 720-600-0370
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHRISTOPHER EDMUNDSON
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Credential |
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Telephone | 720-600-0370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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