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General NPI Number Information
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NPI Number | 1770895989
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Entity Type | Individual
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Provider Name | KENT J KJELLSTROM MPT
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 12/25/2010
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Provider Practice Location Address
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Address Line | 900 N 3RD ST
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City | ROCHELLE
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State | IL
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Zip | 61068-1666
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Country | US
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Telephone | 815-562-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 7733 FORSYTH BLVD STE 2300
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City | SAINT LOUIS
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State | MO
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Zip | 63105-1806
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Country | US
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Telephone | 800-677-1202
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | IL
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