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General NPI Number Information
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NPI Number | 1790746659
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Entity Type | Individual
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Provider Name | BRIAN JON ANDERSON MSPT
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Gender | Male
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 10020 INDIANA AVE STE. 4
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City | RIVERSIDE
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State | CA
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Zip | 92503-5477
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Country | US
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Telephone | 951-637-2320
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Fax | 951-637-2321
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Provider Business Mailing Address
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Address Line | 24630 WASHINGTON AVE STE. 200
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City | MURRIETA
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State | CA
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Zip | 92562-6131
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Country | US
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Telephone | 951-696-9353
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Fax | 951-973-7216
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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 | PT-26276
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License Number State | CA
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