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General NPI Number Information
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NPI Number | 1689790479
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Entity Type | Organization
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Legal Business Name | MAHOPAC PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 880 S LAKE BLVD
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City | MAHOPAC
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State | NY
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Zip | 10541-4765
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Country | US
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Telephone | 845-628-5578
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Fax | 845-628-1654
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Provider Business Mailing Address
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Address Line | PO BOX 940
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City | MAHOPAC
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State | NY
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Zip | 10541-0940
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Country | US
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Telephone | 845-628-5578
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Fax | 845-628-1654
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDWARD W. LUTZ JR.
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Credential | P.T.
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Telephone | 845-628-5578
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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 |
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License Number State |
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