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General NPI Number Information
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NPI Number | 1720303365
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Entity Type | Organization
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Legal Business Name | SUPPLEMENTAL HEALTH CARE
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 32254 BEACON LN
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City | FRASER
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State | MI
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Zip | 48026-2162
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Country | US
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Telephone | 586-296-5532
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Fax |
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Provider Business Mailing Address
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Address Line | 32254 BEACON LN
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City | FRASER
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State | MI
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Zip | 48026-2162
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Country | US
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Telephone | 586-296-5532
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Fax |
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Authorized Official
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Title or Position | RECURTING MANAGER
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Name | MRS. ARIS WOODROOFE
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Credential |
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Telephone | 888-414-7056
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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 | 5502002339
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License Number State | MI
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