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General NPI Number Information
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NPI Number | 1447059092
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Entity Type | Organization
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Legal Business Name | SLIGHT EDGE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 2020 13TH ST
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City | CORALVILLE
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State | IA
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Zip | 52241-1374
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Country | US
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Telephone | 515-210-4268
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 13TH ST
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City | CORALVILLE
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State | IA
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Zip | 52241-1374
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Country | US
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Telephone | 515-210-4268
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GRIFFEN D MCBRIDE
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Credential | DPT, CSCS
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Telephone | 515-210-4268
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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 |
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License Number State |
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