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General NPI Number Information
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NPI Number | 1447114392
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Entity Type | Organization
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Legal Business Name | MUSTARD SEEDS THERAPIES AZ LLC
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 4539 N 22ND ST STE R
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City | PHOENIX
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State | AZ
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Zip | 85016-4639
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Country | US
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Telephone | 786-746-9079
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Fax |
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Provider Business Mailing Address
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Address Line | 9898 SCOTTISH GLEN CT
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City | LAS VEGAS
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State | NV
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Zip | 89178-3854
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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 | OWNER
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Name | THOMAS BOWEN
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Credential | COTA/L
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Telephone | 786-746-9079
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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