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General NPI Number Information
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NPI Number | 1588261622
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Entity Type | Individual
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Provider Name | AMY PAULINE FULFORD PT
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Gender | Female
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 433 S KINZER AVE
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City | NEW HOLLAND
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State | PA
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Zip | 17557-9468
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Country | US
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Telephone | 215-932-8075
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Fax |
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Provider Business Mailing Address
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Address Line | 89 GRAYSON AVE
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City | EAST EARL
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State | PA
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Zip | 17519-9279
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Country | US
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Telephone | 215-932-8075
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT007337L
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License Number State | PA
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