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General NPI Number Information
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NPI Number | 1528395571
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Entity Type | Organization
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Legal Business Name | DYNAMIC THERAPEUTIC CENTER, INC
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 6555 NW 36TH ST SUITE 214
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6978
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Country | US
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Telephone | 786-277-1058
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Fax |
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Provider Business Mailing Address
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Address Line | 6555 NW 36TH ST SUITE 214
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6978
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Country | US
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Telephone | 786-277-1058
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAIN REY BELLO
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Credential |
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Telephone | 786-277-1058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | MA51139
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License Number State | FL
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