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General NPI Number Information
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NPI Number | 1396815189
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Entity Type | Individual
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Provider Name | SCOTT W JENNINGS MSPT
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 E STANLEY BLVD BLDG B, SUITE112
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City | LIVERMORE
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State | CA
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Zip | 94550-4115
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Country | US
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Telephone | 800-919-8090
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Fax | 925-243-0127
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Provider Business Mailing Address
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Address Line | 854 MALIBU DR
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City | CONCORD
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State | CA
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Zip | 94518-2671
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Country | US
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Telephone | 925-969-1628
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Fax | 925-969-1628
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT 20679
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License Number State | CA
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