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General NPI Number Information
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NPI Number | 1578164505
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Entity Type | Organization
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Legal Business Name | IMOVE HEALTH LLC
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 1054 S FARGO ST
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City | CHANDLER
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State | AZ
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Zip | 85286-1078
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Country | US
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Telephone | 480-382-4563
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 W RAY RD STE 6
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City | CHANDLER
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State | AZ
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Zip | 85224-3525
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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 | CO-OWNER, CEO
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Name | DR. RONALD DAVID PEACOCK JR.
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Credential | PT, DPT
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Telephone | 480-382-4563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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