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General NPI Number Information
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NPI Number | 1619936663
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Entity Type | Organization
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Legal Business Name | OPTIMUM REHABILITATION SPECIALISTS
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 11/08/2020
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Provider Practice Location Address
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Address Line | 2718 LEE BLVD #C
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-1537
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Country | US
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Telephone | 239-303-9100
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Fax | 239-303-9101
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Provider Business Mailing Address
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Address Line | PO BOX 3576
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City | APOLLO BEACH
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State | FL
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Zip | 33572-1005
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Country | US
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Telephone | 330-285-0592
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Fax | 888-803-9101
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Authorized Official
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Title or Position | MD
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Name | DR. BRENDAN MALIK
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Credential | MD
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Telephone | 330-285-0592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT0009763
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License Number State | FL
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