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General NPI Number Information
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NPI Number | 1790729952
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Entity Type | Individual
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Provider Name | BRIAN T SUNDAHL DPT
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 19856 SE HIGHWAY 212
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City | DAMASCUS
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State | OR
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Zip | 97089-5743
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Country | US
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Telephone | 417-559-2627
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Fax | 503-386-2745
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Provider Business Mailing Address
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Address Line | 372 SOUTH BROADWAY
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City | ESTACADA
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State | OR
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Zip | 97023
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Country | US
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Telephone | 503-630-5314
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Fax | 503-630-5315
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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 | PT00008548
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5367
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License Number State | OR
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