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General NPI Number Information
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NPI Number | 1508063652
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Entity Type | Organization
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Legal Business Name | LAPORTE REGIONAL HOSPITAL
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1203 WASHINGTON ST
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City | LA PORTE
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State | IN
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Zip | 46350-3221
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Country | US
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Telephone | 219-326-2397
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 WASHINGTON ST
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City | LA PORTE
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State | IN
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Zip | 46350-3221
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Country | US
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Telephone | 219-326-2397
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPISTS' ASSISTANT
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Name | MS. HEATHER Y. GOFF
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Credential | P.T.A.
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Telephone | 219-326-2397
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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 | 06001316A
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License Number State | IN
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