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General NPI Number Information
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NPI Number | 1699584508
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Entity Type | Individual
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Provider Name | TORY BASILIS
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Gender | Female
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 5998 CENTRE ST STE F
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City | MELROSE
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State | FL
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Zip | 32666-6208
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Country | US
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Telephone | 352-316-2922
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | LAKE GENEVA
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State | FL
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Zip | 32160-0055
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Country | US
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Telephone | 352-316-2922
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA73666
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License Number State | FL
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