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General NPI Number Information
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NPI Number | 1720988413
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Entity Type | Individual
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Provider Name | PEARL MAE YU RONG HETTICH DPT
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Gender | Male
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 269 MIDDLE TPKE W
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City | MANCHESTER
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State | CT
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Zip | 06040-3834
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Country | US
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Telephone | 186-053-3035
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Fax |
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Provider Business Mailing Address
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Address Line | 2999 OLYMPUS BLVD STE 500
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City | COPPELL
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State | TX
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Zip | 75019-1205
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Country | US
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Telephone | 866-871-8519
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 15717
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License Number State | CT
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