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General NPI Number Information
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NPI Number | 1700997061
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Entity Type | Organization
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Legal Business Name | HEALTHCORE INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 606 SE BAYA DR
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City | LAKE CITY
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State | FL
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Zip | 32025-6026
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Country | US
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Telephone | 386-755-8680
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Fax | 386-755-6639
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Provider Business Mailing Address
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Address Line | PO BOX 2181
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City | LAKE CITY
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State | FL
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Zip | 32056-2181
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Country | US
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Telephone | 386-754-3908
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Fax | 386-754-9059
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. KENNETH A WATSON
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Credential | NA
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Telephone | 386-754-3908
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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 |
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License Number State |
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