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General NPI Number Information
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NPI Number | 1306354881
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Entity Type | Organization
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Legal Business Name | IGNITE PHYZIO & SPORTS PERFORMANCE INC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 811 E LAMBERT RD
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City | LA HABRA
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State | CA
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Zip | 90631-6143
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Country | US
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Telephone | 562-896-0129
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 SHADY BROOK DR
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City | FULLERTON
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State | CA
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Zip | 92831-1850
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Country | US
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Telephone | 562-896-0129
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZIAD DAHDUL
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Credential | PT
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Telephone | 562-896-0129
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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 | PT37147
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License Number State | CA
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