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General NPI Number Information
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NPI Number | 1568733020
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Entity Type | Organization
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Legal Business Name | LAVIE REHAB
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Dates
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Enumeration Date | 01/15/2012
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Last Update Date | 01/15/2012
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Provider Practice Location Address
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Address Line | 626 N TYNDALL PKWY
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City | PANAMA CITY
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State | FL
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Zip | 32404-6132
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Country | US
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Telephone | 850-871-3836
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Fax |
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Provider Business Mailing Address
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Address Line | 802 FLIGHT AVE
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City | PANAMA CITY
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State | FL
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Zip | 32404-5967
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Country | US
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Telephone | 850-819-4911
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Fax |
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Authorized Official
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Title or Position | COTA/L
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Name | CHRIS A MANFREDI
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Credential |
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Telephone | 850-819-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | FL OTA 303
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License Number State | FL
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