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General NPI Number Information
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NPI Number | 1669212239
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Entity Type | Organization
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Legal Business Name | MYOFASCIAL RELEASE AND WOMEN'S HEALTH LLC
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 1527 DALE MABRY HWY STE 105
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City | LUTZ
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State | FL
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Zip | 33548-3031
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Country | US
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Telephone | 813-482-5765
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Fax |
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Provider Business Mailing Address
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Address Line | 21514 CORMORANT COVE DR
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City | LAND O LAKES
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State | FL
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Zip | 34637-7523
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Country | US
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Telephone | 813-482-5765
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | KATHLEEN J HENNESSY
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Credential | DPT
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Telephone | 813-482-5765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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