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General NPI Number Information
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NPI Number | 1386314482
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Entity Type | Organization
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Legal Business Name | MED QUAD SPINE CENTER
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 4125 CLEVELAND AVE STE 1870
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City | FORT MYERS
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State | FL
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Zip | 33901-9064
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Country | US
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Telephone | 239-400-0956
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Fax | 239-400-0109
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Provider Business Mailing Address
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Address Line | 9858 CLINT MOORE RD # C111-274
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 561-482-1144
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Fax | 561-482-1145
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | HOLLY SCHISANI
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Credential | DO
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Telephone | 561-482-1144
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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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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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