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General NPI Number Information
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NPI Number | 1326162280
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Entity Type | Individual
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Provider Name | REINALDO MANZO JR.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1607 SAINT JAMES CT
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5352
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Country | US
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Telephone | 850-878-0191
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 STONEY CREEK WAY
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City | TALLAHASSEE
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State | FL
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Zip | 32317-9434
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Country | US
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Telephone | 850-942-6853
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA17605
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License Number State | FL
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