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General NPI Number Information
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NPI Number | 1518618396
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Entity Type | Organization
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Legal Business Name | RE-HYDRATE WELLNESS LLC
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 1329 CHERRY WAY DR STE 205
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City | COLUMBUS
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State | OH
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Zip | 43230-6781
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Country | US
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Telephone | 614-317-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 574 IRVINE LOOP
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City | DELAWARE
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State | OH
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Zip | 43015-7699
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Country | US
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Telephone | 614-309-2484
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FLORENCE AYODELE
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Credential | RN
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Telephone | 614-309-2484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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