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General NPI Number Information
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NPI Number | 1487869368
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Entity Type | Individual
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Provider Name | KAMIL DOSTALIK PT
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Gender | Male
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1135 N COMMERCIAL AVE
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City | SAINT CLAIR
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State | MO
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Zip | 63077-1012
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Country | US
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Telephone | 636-629-8110
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Fax | 636-583-8960
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Provider Business Mailing Address
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Address Line | 20 STABLESTONE DR
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City | UNION
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State | MO
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Zip | 63084-4417
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Country | US
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Telephone | 636-629-8110
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Fax | 636-583-8960
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 02070
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License Number State | MO
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