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General NPI Number Information
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NPI Number | 1730386640
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Entity Type | Individual
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Provider Name | JOFFREE J. BASILISCO P.T.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 1023 W MAIN ST
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City | VEVAY
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State | IN
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Zip | 47043-9192
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Country | US
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Telephone | 812-427-2803
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Fax |
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Provider Business Mailing Address
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Address Line | 10 S 9TH ST STE 4
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City | NOBLESVILLE
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State | IN
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Zip | 46060-2631
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Country | US
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Telephone | 765-524-3946
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Fax | 317-708-6496
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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 | 003680
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05007999A
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License Number State | IN
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