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General NPI Number Information
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NPI Number | 1326300013
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Entity Type | Organization
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Legal Business Name | SYNERGY PHYSICAL THERAPY & SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 06/09/2012
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Last Update Date | 06/09/2012
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Provider Practice Location Address
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Address Line | 233 BELL FORK RD
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City | JACKSONVILLE
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State | NC
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Zip | 28540-6471
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Country | US
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Telephone | 252-349-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 220 BLUEWATER CV
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City | CAPE CARTERET
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State | NC
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Zip | 28584-9401
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Country | US
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Telephone | 252-349-9090
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR/OWNER
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Name | MRS. KIRA PORTER BOYD
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Credential | MSPT, ATC
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Telephone | 252-626-0888
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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 |
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License Number State | NC
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