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General NPI Number Information
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NPI Number | 1528501178
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Entity Type | Organization
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Legal Business Name | LEGACY HEALHCARE SERVICES, INC.
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 3050 WOODMONT AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3800
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Country | US
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Telephone | 863-875-6584
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 WOODMONT AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3800
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | ROSE CARTER
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Credential |
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Telephone | 919-327-9674
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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 | PT 04827
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License Number State | FL
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