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General NPI Number Information
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NPI Number | 1528298296
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Entity Type | Organization
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Legal Business Name | MGH REVERE HEALTHCARE CENTRE
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 300 OCEAN AVE
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City | REVERE
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State | MA
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Zip | 02151-3675
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Country | US
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Telephone | 781-485-6222
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Fax | 781-485-6232
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Provider Business Mailing Address
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Address Line | 190 MOUNTAIN AVE APT # 404
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City | MALDEN
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State | MA
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Zip | 02148-2762
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Country | US
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Telephone | 508-615-9191
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Fax |
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Authorized Official
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Title or Position | STAFF PHYSICAL THERAPIST
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Name | RUCHITA VORA
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Credential | PT, MSPT
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Telephone | 17814856222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 18434
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License Number State | MA
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