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General NPI Number Information
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NPI Number | 1669551024
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Entity Type | Individual
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Provider Name | ANGELA ST. LOUIS RISIGO PT
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 744 MIDDLETOWN RD
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City | COLCHESTER
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State | CT
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Zip | 06415-2307
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Country | US
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Telephone | 860-365-5514
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Fax | 860-499-5356
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Provider Business Mailing Address
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Address Line | 15 CARRIAGE DR
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City | EAST HAMPTON
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State | CT
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Zip | 06424-1878
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Country | US
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Telephone | 860-268-3226
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Fax | 860-499-5356
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4130
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License Number State | SC
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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 | 006488
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License Number State | CT
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