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General NPI Number Information
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NPI Number | 1487827093
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Entity Type | Individual
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Provider Name | LYNNE MICHELLE MARGOLIS P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 875 S VANGUARD WAY STE 110
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City | MERIDIAN
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State | ID
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Zip | 83642-8541
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Country | US
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Telephone | 208-463-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 215 E HAWAII AVE
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City | NAMPA
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State | ID
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Zip | 83686-6011
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Country | US
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Telephone | 208-463-3000
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 120505-2401
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | PT-8371
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License Number State | ID
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