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General NPI Number Information
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NPI Number | 1487741617
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Entity Type | Organization
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Legal Business Name | ADVANCED MOBILITY REPAIR
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 21645 OREGON TRL
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City | CENTRALIA
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State | WA
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Zip | 98531-9617
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Country | US
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Telephone | 360-219-1102
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Fax | 360-237-0561
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Provider Business Mailing Address
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Address Line | 1411 NW LOUISIANA AVE SUITE 140
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City | CHEHALIS
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State | WA
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Zip | 98532-1749
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Country | US
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Telephone | 360-219-1102
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Fax | 360-237-0561
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Authorized Official
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Title or Position | OWNER
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Name | KAZON ROTZ
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Credential |
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Telephone | 360-219-1102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 602621899
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License Number State | WA
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