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General NPI Number Information
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NPI Number | 1619576907
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Entity Type | Organization
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Legal Business Name | RESTORATIVE MANUAL PHYSICAL THERAPY & FITNESS LLC
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 601 W PLANO PKWY STE 141A
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City | PLANO
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State | TX
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Zip | 75075-8969
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Country | US
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Telephone | 972-398-0789
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Fax |
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Provider Business Mailing Address
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Address Line | 3521 WILSHIRE WAY APT 4123
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City | RICHARDSON
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State | TX
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Zip | 75082-0080
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Country | US
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Telephone | 216-233-4298
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/OWNER
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Name | MS. LORETTA MICHELLE WEST
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Credential | PT
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Telephone | 216-233-4298
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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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