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General NPI Number Information
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NPI Number | 1306256987
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Entity Type | Organization
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Legal Business Name | CORAL SPRINGS PHYSICAL MEDICINE, INC.
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 9720 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4004
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Country | US
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Telephone | 954-752-7373
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Fax | 954-752-7351
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Provider Business Mailing Address
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Address Line | 9858 CLINT MOORE RD C111-274
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 561-482-1144
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Fax | 561-482-1145
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Authorized Official
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Title or Position | OWNER
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Name | ALIYAH STOTTER
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Credential |
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Telephone | 954-752-7373
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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 | CH9519
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License Number State | FL
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