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General NPI Number Information
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NPI Number | 1508579459
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Entity Type | Individual
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Provider Name | TOM DONOFRIO LMBT
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Gender | Male
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 1310 SE MAYNARD RD STE 103
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City | CARY
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State | NC
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Zip | 27511-3615
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Country | US
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Telephone | 919-413-6481
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Fax |
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Provider Business Mailing Address
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Address Line | 780 TREVISO LN
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City | APEX
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State | NC
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Zip | 27502-2185
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Country | US
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Telephone | 919-413-6481
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7921
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License Number State | NC
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