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General NPI Number Information
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NPI Number | 1609279017
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Entity Type | Organization
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Legal Business Name | NORTHWEST RETURN TO WORK MT VERNON
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 1600 ROOSEVELT AVE SUITE B
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City | MOUNT VERNON
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State | WA
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Zip | 98273-2646
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Country | US
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Telephone | 360-424-5215
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Fax | 360-424-4074
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Provider Business Mailing Address
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Address Line | 1600 ROOSEVELT AVE SUITE B
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City | MOUNT VERNON
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State | WA
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Zip | 98273-2646
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Country | US
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Telephone | 360-424-5215
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Fax | 360-424-4074
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Authorized Official
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Title or Position | OWNER
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Name | MR. TROY STANG
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Credential | MS,PT
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Telephone | 360-424-5215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT00006201
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License Number State | WA
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