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General NPI Number Information
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NPI Number | 1528033032
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Entity Type | Organization
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Legal Business Name | NEURO REHAB & LYPHMOEDEMA CARE CENTER
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Dates
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Enumeration Date | 02/18/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 2611 SUNBURST DR
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City | MIDLAND
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State | TX
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Zip | 79707-5111
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Country | US
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Telephone | 432-520-2859
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Fax | 432-520-2861
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Provider Business Mailing Address
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Address Line | 2611 SUNBURST DR
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City | MIDLAND
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State | TX
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Zip | 79707-5111
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Country | US
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Telephone | 432-520-2859
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Fax | 432-520-2861
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Authorized Official
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Title or Position | OWNER
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Name | MISS NANDA N AMBORE
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Credential | OTR,CLT-LANA
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Telephone | 432-520-2859
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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 | 552830000
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License Number State | TX
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