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General NPI Number Information
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NPI Number | 1770362923
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Entity Type | Organization
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Legal Business Name | LEGACY THERAPY AND REHAB TRI-STATE LLC
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 8520 GUNPOWDER RD
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City | FLORENCE
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State | KY
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Zip | 41042-2450
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Country | US
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Telephone | 859-534-2436
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Fax | 859-817-0968
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Provider Business Mailing Address
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Address Line | PO BOX 3276
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City | EVANSVILLE
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State | IN
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Zip | 47731-3276
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Country | US
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Telephone | 812-473-0181
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Fax | 812-492-6498
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY SCHANTZ
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Credential |
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Telephone | 812-473-0181
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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 |
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License Number State |
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