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General NPI Number Information
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NPI Number | 1578290060
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Entity Type | Individual
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Provider Name | ANGELO MOISE
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Gender | Male
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 9711 W OAKLAND PARK BLVD
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City | SUNRISE
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State | FL
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Zip | 33351-7013
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Country | US
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Telephone | 305-928-0058
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Fax |
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Provider Business Mailing Address
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Address Line | 3651 TURTLE RUN BLVD APT 818
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4237
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Country | US
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Telephone | 305-928-0058
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 25993
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License Number State | FL
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