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General NPI Number Information
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NPI Number | 1689047748
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Entity Type | Organization
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Legal Business Name | PAOLA WELLNESS LLC
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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 | 302 CALIFORNIA AVE SUITE 202
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City | WAHIAWA
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State | HI
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Zip | 96786-1841
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Country | US
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Telephone | 808-679-2686
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 75424
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City | KAPOLEI
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State | HI
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Zip | 96707-0424
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Country | US
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Telephone | 808-679-2686
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. MAILE COLLADO
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Credential | MPT
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Telephone | 808-679-2686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1484
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License Number State | HI
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