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General NPI Number Information
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NPI Number | 1780001727
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Entity Type | Individual
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Provider Name | MICHAEL PAUL BLAIR PT
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Gender | Male
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 1000 GREG KRUSCHEK AVE
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City | NOME
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State | AK
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Zip | 98762
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Country | US
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Telephone | 907-443-4513
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Fax |
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Provider Business Mailing Address
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Address Line | 2049 N D ST
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City | FREMONT
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State | NE
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Zip | 68025-3031
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Country | US
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Telephone | 402-719-7508
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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 | 2739
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License Number State | AK
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