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General NPI Number Information
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NPI Number | 1497627905
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Entity Type | Individual
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Provider Name | JIMMYE ABSOOD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 18800 MAIN ST STE A
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City | GROVELAND
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State | CA
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Zip | 95321-9470
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Country | US
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Telephone | 209-562-4035
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Fax | 209-962-5399
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Provider Business Mailing Address
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Address Line | 16156 HARMONY RANCH DR
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City | DELHI
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State | CA
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Zip | 95315-9390
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Country | US
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Telephone | 209-238-5079
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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 | 52967
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License Number State | CA
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