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General NPI Number Information
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NPI Number | 1588178297
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Entity Type | Organization
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Legal Business Name | SHINING STAR PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 1700 GREAT NECK RD
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City | COPIAGUE
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State | NY
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Zip | 11726-2723
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Country | US
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Telephone | 631-608-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 18501 HILLSIDE AVE APT 1C
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City | JAMAICA
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State | NY
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Zip | 11432-4800
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Country | US
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Telephone | 347-392-8515
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MYRA RANADA LABIAL
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Credential | MS PT
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Telephone | 347-392-8515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 029064-1
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License Number State | NY
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