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General NPI Number Information
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NPI Number | 1437528338
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Entity Type | Individual
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Provider Name | CLIFFORD BYRON ROSS II
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Gender | Male
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 2116 E SECTION ST STE B
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City | MOUNT VERNON
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State | WA
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Zip | 98274-9124
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Country | US
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Telephone | 360-873-8356
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Fax | 360-899-4641
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Provider Business Mailing Address
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Address Line | PO BOX 505
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City | LA CONNER
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State | WA
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Zip | 98257-0505
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Country | US
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Telephone | 360-873-8356
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Fax | 360-899-4641
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P160570116
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License Number State | WA
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