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General NPI Number Information
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NPI Number | 1730689670
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Entity Type | Individual
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Provider Name | KENT LEWIS VALENTE JR. LMT
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Gender | Male
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 4370 SE KING RD STE 220
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City | MILWAUKIE
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State | OR
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Zip | 97222-1613
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Country | US
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Telephone | 503-654-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 11908 SE 36TH AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-6904
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Country | US
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Telephone | 503-839-8587
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18496
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License Number State | OR
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