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General NPI Number Information
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NPI Number | 1659609378
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Entity Type | Individual
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Provider Name | MICHAEL SMITH
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Gender | Male
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 10100 HILLVEIW DR.
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City | PENSACOLA
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State | FL
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Zip | 32514
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Country | US
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Telephone | 850-478-5153
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Fax |
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Provider Business Mailing Address
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Address Line | 413 CANTERBURY LN
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City | GULF BREEZE
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State | FL
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Zip | 32561-4416
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA21818
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License Number State | FL
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