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General NPI Number Information
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NPI Number | 1346205598
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE PHYSICAL THERAPY CLINIC
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3440 S POST RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-8301
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Country | US
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Telephone | 317-862-2860
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Fax | 317-862-0928
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Provider Business Mailing Address
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Address Line | 8601 CREEKWOOD LN
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-9211
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Country | US
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Telephone | 317-826-8866
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ABOL DADFARMAY
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Credential |
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Telephone | 317-826-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05001800A
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License Number State | IN
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