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General NPI Number Information
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NPI Number | 1679946750
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Entity Type | Individual
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Provider Name | RYAN FAYLUGA ACOLICOL PT
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Gender | Male
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 55 LAKEVIEW AVE APT A LEONIA
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City | LEONIA
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State | NJ
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Zip | 07605-3102
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Country | US
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Telephone | 917-691-5201
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Fax |
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Provider Business Mailing Address
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Address Line | 349 BRILLANTES SUBDIVISION, GOV. RAMOS STREET STA. MARIA
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City | ZAMBOANGA CITY
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State | ZAMBOANGA DEL SUR
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Zip | 7000
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Country | PH
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 038034-1
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License Number State | NY
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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 | PT024806
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0019900
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License Number State | ZZ
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