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General NPI Number Information
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NPI Number | 1518162379
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Entity Type | Individual
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Provider Name | KERRINA L CRAGUN R.P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 1821 WILSHIRE BLVD SUITE 570
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City | SANTA MONICA
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State | CA
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Zip | 90403-5618
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Country | US
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Telephone | 661-600-3997
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Fax | 661-222-7681
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Provider Business Mailing Address
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Address Line | PO BOX 801931
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City | SANTA CLARITA
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State | CA
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Zip | 91380-1931
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Country | US
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Telephone | 661-600-3997
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Fax | 661-222-7681
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT22518
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License Number State | CA
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