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General NPI Number Information
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NPI Number | 1346442324
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY HOMECARE
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Dates
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Enumeration Date | 06/02/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 160 KEONEKAI RD
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City | KIHEI
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State | HI
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Zip | 96753-7123
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Country | US
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Telephone | 808-250-6260
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6359
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City | KAHULUI
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State | HI
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Zip | 96733-6359
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER LLC, PHYSICAL THERAPIST
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Name | MRS. AMANDA PROBERT ELLER
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Credential | MPT
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Telephone | 808-250-6260
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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 | 1859
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License Number State | HI
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