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General NPI Number Information
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NPI Number | 1295047769
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Entity Type | Organization
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Legal Business Name | MATRIX THERAPY SOLUTIONS, LLC
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 5024 CUT OFF RD STE B
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City | COUSHATTA
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State | LA
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Zip | 71019-5116
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Country | US
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Telephone | 318-560-7300
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Fax | 318-932-7946
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Provider Business Mailing Address
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Address Line | 1035 HICKORY DR
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City | COUSHATTA
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State | LA
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Zip | 71019-8164
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Country | US
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Telephone | 318-560-7300
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Fax | 318-932-7946
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | MRS. BRIDGETTE NEAL BATES
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Credential | OT
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Telephone | 318-560-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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