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General NPI Number Information
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NPI Number | 1740312289
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Entity Type | Individual
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Provider Name | MRS. KATHLEEN COSGRAVE BAGWELL
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Gender | Female
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Dates
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Enumeration Date | 03/11/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 839 NW 81ST TER
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City | PLANTATION
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State | FL
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Zip | 33324-1209
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Country | US
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Telephone | 954-608-3075
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Fax | 954-530-7240
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Provider Business Mailing Address
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Address Line | 2810 OLD ORCHARD RD
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City | DAVIE
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State | FL
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Zip | 33328-6913
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Country | US
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Telephone | 954-474-0182
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Fax | 954-474-0182
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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 | PT20562
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License Number State | FL
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