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General NPI Number Information
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NPI Number | 1659616555
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Entity Type | Individual
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Provider Name | SAMUEL CORNELL P.T.
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Gender | Male
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 09/20/2025
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Provider Practice Location Address
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Address Line | 600 COUNTRY CLUB RD
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City | EUGENE
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State | OR
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Zip | 97401-2240
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Country | US
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Telephone | 541-242-4172
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Fax |
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Provider Business Mailing Address
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Address Line | 615 PIIKOI ST STE 1210
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City | HONOLULU
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State | HI
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Zip | 96814-3141
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Country | US
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Telephone | 808-596-7300
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Fax | 808-596-7305
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT3568
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License Number State | HI
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