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General NPI Number Information
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NPI Number | 1508393174
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Entity Type | Organization
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Legal Business Name | ORTHOCARE PHYSICAL THERAPY CENTER, LLC
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 05/15/2017
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Provider Practice Location Address
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Address Line | 13135 LEE JACKSON MEMORIAL HWY STE 320
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City | FAIRFAX
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State | VA
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Zip | 22033-1907
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Country | US
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Telephone | 703-349-5324
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Fax |
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Provider Business Mailing Address
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Address Line | 5290 JULE STAR DR
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City | CENTREVILLE
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State | VA
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Zip | 20120-3006
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Country | US
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Telephone | 703-349-5324
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHRUTI AMBEGAONKAR
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Credential | PT, DPT
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Telephone | 703-349-5324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305205344
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License Number State | VA
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