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General NPI Number Information
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NPI Number | 1356917934
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Entity Type | Organization
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Legal Business Name | CELLOSCOPE INC
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 13791 SAXON LAKE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32225-2624
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Country | US
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Telephone | 609-306-9729
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Fax |
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Provider Business Mailing Address
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Address Line | 127 W 30TH ST FL 10
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City | NEW YORK
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State | NY
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Zip | 10001-3406
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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 | CLINICAL MANAGER
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Name | DR. STEPHANIE WAKEMAN
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Credential | DPT
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Telephone | 609-306-9729
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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 |
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License Number State |
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