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General NPI Number Information
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NPI Number | 1407109143
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Entity Type | Organization
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Legal Business Name | BAYCARE HEALTH SYSTEM
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 1200 7TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33705-1300
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Country | US
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Telephone | 727-825-1231
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Fax |
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Provider Business Mailing Address
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Address Line | 4802 51ST ST W #1303
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City | BRADENTON
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State | FL
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Zip | 34210-5101
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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 | LICENSED PHYSICAL THERAPIST ASSIST.
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Name | MS. BARBARA MALCOLM CUDAR
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Credential |
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Telephone | 727-825-1231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | PTA 287
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License Number State | FL
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