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General NPI Number Information
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NPI Number | 1578796470
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Entity Type | Individual
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Provider Name | JOHN F BETLACH M.T.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 77-6425 KUAKINI HWY
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City | KAILUA KONA
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State | HI
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Zip | 96740-3213
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Country | US
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Telephone | 808-557-1420
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 390562
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City | KEAUHOU
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State | HI
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Zip | 96739-0562
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Country | US
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Telephone | 808-557-1420
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MASSAGE THER. #7144
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License Number State | HI
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