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General NPI Number Information
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NPI Number | 1659572147
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Entity Type | Organization
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Legal Business Name | COREBALANCE THERAPY LLC
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 906 W UNIVERSITY AVE SUITE 120
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 928-556-9935
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Fax | 928-774-4277
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Provider Business Mailing Address
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Address Line | 906 W UNIVERSITY AVE SUITE 120
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 928-556-9935
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Fax | 928-774-4277
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Authorized Official
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Title or Position | CO-OWNER
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Name | AMY FLORY
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Credential | PT, DPT
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Telephone | 928-556-9935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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