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General NPI Number Information
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NPI Number | 1376992594
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Entity Type | Organization
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Legal Business Name | MOJO PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 2211 NW PROFESSIONAL DR SUITE 204
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City | CORVALLIS
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State | OR
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Zip | 97330-3891
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Country | US
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Telephone | 541-207-3720
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Fax | 541-207-3729
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Provider Business Mailing Address
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Address Line | 2211 NW PROFESSIONAL DR SUITE 204
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City | CORVALLIS
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State | OR
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Zip | 97330-3891
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Country | US
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Telephone | 541-207-3720
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Fax | 541-207-3729
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Authorized Official
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Title or Position | PWNER
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Name | JAMES KEVIN THOMASON
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Credential | PT
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Telephone | 541-915-3811
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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 | 60894
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License Number State | OR
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