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General NPI Number Information
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NPI Number | 1518474998
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Entity Type | Organization
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Legal Business Name | ATLAS PHYSICAL THERAPY CENTER, LLC
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Dates
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Enumeration Date | 01/06/2018
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 1166 CAMP CREEK RD
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City | LANCASTER
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State | SC
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Zip | 29720-8558
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Country | US
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Telephone | 803-804-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 WHITE FAWN LN
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City | ROCK HILL
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State | SC
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Zip | 29730-6388
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Country | US
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Telephone | 843-364-2612
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JIMAKI ROACH
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Credential | PT
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Telephone | 843-364-2612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4579
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License Number State | SC
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