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General NPI Number Information
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NPI Number | 1548386352
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Entity Type | Individual
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Provider Name | MR. EDWARD W. LUTZ
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 880 S LAKE BLVD
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City | MAHOPAC
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State | NY
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Zip | 10541-4771
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Country | US
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Telephone | 845-628-5578
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Fax | 845-628-1654
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Provider Business Mailing Address
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Address Line | PO BOX 940
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City | MAHOPAC
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State | NY
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Zip | 10541-0940
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Country | US
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Telephone | 845-628-5578
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Fax | 845-628-1654
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6185
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License Number State | NY
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