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General NPI Number Information
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NPI Number | 1710324850
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Entity Type | Organization
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Legal Business Name | THERAPYPROS, LLC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 11/30/2014
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Provider Practice Location Address
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Address Line | 117 E SPRINGFIELD ST
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City | SAINT JAMES
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State | MO
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Zip | 65559-1646
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Country | US
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Telephone | 573-265-1105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 778
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City | SAINT JAMES
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State | MO
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Zip | 65559-0778
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Country | US
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Telephone | 573-265-1105
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | DIANA J BRANDT
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Credential | PT
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Telephone | 573-265-1105
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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 | 200174333
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License Number State | MO
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