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General NPI Number Information
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NPI Number | 1619551967
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Entity Type | Individual
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Provider Name | CULLEN VALIER COGBURN
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Gender | Male
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 259 MAIN ST
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City | YARMOUTH
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State | ME
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Zip | 04096-4703
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Country | US
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Telephone | 207-780-8860
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Fax |
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Provider Business Mailing Address
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Address Line | 100 GANNETT DR STE C
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5900
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Country | US
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Telephone | 207-828-0361
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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 |
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License Number State |
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