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General NPI Number Information
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NPI Number | 1457897241
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Entity Type | Organization
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Legal Business Name | PATH MEDICAL, LLC
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 11285 SW 211TH ST STE 302
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City | MIAMI
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State | FL
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Zip | 33189-2213
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Country | US
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Telephone | 386-960-2345
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Fax | 386-960-2350
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Provider Business Mailing Address
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Address Line | 2304 W OAKLAND PARK BLVD
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City | OAKLAND PARK
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State | FL
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Zip | 33311-1422
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Country | US
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Telephone | 754-218-2164
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Fax | 407-730-9928
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Authorized Official
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Title or Position | DIRECTOR OF MEDICAL SERVICES
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Name | DR. NEIL BONNARDALE
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Credential | D.C.
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Telephone | 754-218-2164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | HCC8638
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License Number State | FL
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