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General NPI Number Information
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NPI Number | 1316858046
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Entity Type | Individual
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Provider Name | ALLISA MARRIOTT
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Gender | Female
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 53880 CARMICHAEL DR
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City | SOUTH BEND
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State | IN
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Zip | 46635-1567
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Country | US
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Telephone | 574-247-9441
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Fax |
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Provider Business Mailing Address
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Address Line | 1656 N ADAMS ST
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City | SOUTH BEND
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State | IN
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Zip | 46628-3027
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Country | US
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Telephone | 574-261-3024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 05016584A
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License Number State | IN
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