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General NPI Number Information
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NPI Number | 1710247747
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Entity Type | Individual
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Provider Name | CHAD WADE WOMACK PT
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Gender | Male
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 1601 ALDERSGATE ROAD
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City | LITTLE ROCK
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State | AR
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Zip | 72205
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Country | US
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Telephone | 501-687-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 166 MOUNTAIN VALLEY DR
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City | MAUMELLE
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State | AR
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Zip | 72113-6993
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Country | US
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Telephone | 501-912-5613
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2345
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License Number State | AR
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