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General NPI Number Information
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NPI Number | 1780233494
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Entity Type | Individual
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Provider Name | AMY ELIZABETH WEISSE DPT
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Gender | Female
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 4330 SOUTHPORT SUPPLY RD SE STE 201
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City | SOUTHPORT
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State | NC
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Zip | 28461-9273
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Country | US
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Telephone | 901-457-0113
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Fax |
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Provider Business Mailing Address
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Address Line | 109 PIER MASTER PT UNIT 201
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City | WILMINGTON
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State | NC
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Zip | 28412-5602
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Country | US
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Telephone |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 3637
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License Number State | NC
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