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General NPI Number Information
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NPI Number | 1790011716
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Entity Type | Organization
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Legal Business Name | PULMONARY PROVIDERS REHAB INC.
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 1352 SW 75TH AVE
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City | MIAMI
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State | FL
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Zip | 33144-4422
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Country | US
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Telephone | 305-266-4474
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Fax | 305-266-4474
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Provider Business Mailing Address
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Address Line | 1352 SW 75TH AVE
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City | MIAMI
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State | FL
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Zip | 33144-4422
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Country | US
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Telephone | 305-266-4474
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Fax | 305-266-4474
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. RAFAEL JORGE MENENDEZ
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Credential |
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Telephone | 305-266-4474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | RT5541 AND TN7986
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License Number State | FL
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