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General NPI Number Information
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NPI Number | 1710659909
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Entity Type | Individual
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Provider Name | AARON A GUSTUM DPT
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Gender | Male
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 2751 COMMERCIAL BLVD STE 5
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City | LAKE HALLIE
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State | WI
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Zip | 54729-5080
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Country | US
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Telephone | 800-974-4378
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Fax | 630-515-1536
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Provider Business Mailing Address
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Address Line | 24014 W RENWICK RD UNIT 206
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City | PLAINFIELD
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State | IL
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Zip | 60544-8711
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Country | US
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Telephone | 800-974-4378
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Fax | 630-515-1536
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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 |
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License Number State |
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