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General NPI Number Information
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NPI Number | 1467575449
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Entity Type | Individual
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Provider Name | MICHELLE LUZ FOY PTA, LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 3434 GROVE ST
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City | LEMON GROVE
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State | CA
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Zip | 91945-1812
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Country | US
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Telephone | 619-281-3706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | LA MESA
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State | CA
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Zip | 91944-0057
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Country | US
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Telephone | 619-466-9245
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Fax |
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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 | AT 563
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 64462
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License Number State | CA
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