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General NPI Number Information
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NPI Number | 1609531607
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Entity Type | Organization
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Legal Business Name | BEACON THERAPIES INC.
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 10740 OLD US HIGHWAY 27 S
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City | GAYLORD
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State | MI
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Zip | 49735
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Country | US
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Telephone | 989-448-2364
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 ROSENBURG RD NE
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City | KALKASKA
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State | MI
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Zip | 49646-9643
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Country | US
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Telephone | 218-590-4603
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | COREY PRANGER
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Credential |
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Telephone | 218-590-4603
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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