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General NPI Number Information
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NPI Number | 1609022458
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Entity Type | Individual
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Provider Name | MITA PATEL PT
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Gender | Female
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 2811 WILSHIRE BLVD STE 690
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City | SANTA MONICA
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State | CA
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Zip | 90403-4816
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Country | US
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Telephone | 310-828-7239
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 MALCOLM AVE APT 202
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City | LOS ANGELES
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State | CA
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Zip | 90024-5762
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Country | US
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Telephone | 310-922-2196
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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 | 26628
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License Number State | CA
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