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General NPI Number Information
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NPI Number | 1427470079
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Entity Type | Organization
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Legal Business Name | LYMPHATIC SPECIALISTS, INC
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 1701 NW 82ND AVE
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City | DORAL
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State | FL
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Zip | 33126-1015
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Country | US
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Telephone | 786-442-1700
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Fax | 305-504-8897
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Provider Business Mailing Address
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Address Line | 6990 SW 110TH CT
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City | MIAMI
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State | FL
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Zip | 33173-2125
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Country | US
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Telephone | 786-442-1700
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Fax | 305-504-8897
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | LAURA CASTROVIEJO
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Credential |
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Telephone | 786-201-1703
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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 | PT20858
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License Number State | FL
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