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General NPI Number Information
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NPI Number | 1568546711
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Entity Type | Organization
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Legal Business Name | UNITED THERAPY NETWORK
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10841 WHITE OAK AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3811
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Country | US
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Telephone | 909-948-0411
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Fax |
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Provider Business Mailing Address
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Address Line | 15362 GARFIELD DR
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City | FONTANA
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State | CA
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Zip | 92336-4015
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Country | US
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Telephone | 909-574-6192
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. CIVILLANI DELAPENA LAYOS
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Credential | MPT
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Telephone | 909-641-1885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 28911
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License Number State | CA
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