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General NPI Number Information
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NPI Number | 1760841977
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE MEDICAL, LLC.
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 10582 LOVELAND MADEIRA RD
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City | LOVELAND
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State | OH
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Zip | 45140-8962
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Country | US
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Telephone | 513-760-0887
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Fax |
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Provider Business Mailing Address
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Address Line | 4229 BARDSTOWN RD STE 214
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City | LOUISVILLE
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State | KY
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Zip | 40218-3241
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Country | US
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Telephone | 502-565-1895
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DAVID STONE
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Credential |
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Telephone | 502-565-1895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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