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General NPI Number Information
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NPI Number | 1699083931
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Entity Type | Organization
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Legal Business Name | TRI R WELLNESS CENTER
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 1414 NW 107TH AVE STE 214
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City | DORAL
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State | FL
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Zip | 33172-2732
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Country | US
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Telephone | 305-477-5151
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Fax | 305-477-5103
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Provider Business Mailing Address
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Address Line | 1414 NW 107TH AVE STE 214
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City | DORAL
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State | FL
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Zip | 33172-2732
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Country | US
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Telephone | 305-477-5151
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Fax | 305-477-5103
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Authorized Official
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Title or Position | OWNER
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Name | MARCOS REMEDIO
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Credential |
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Telephone | 305-477-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MM24985
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License Number State | FL
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