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General NPI Number Information
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NPI Number | 1790996304
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC HEALTH INC.
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 1337 BLUE SAGE WAY
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City | CHULA VISTA
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State | CA
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Zip | 91915-1616
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Country | US
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Telephone | 619-398-6990
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Fax | 619-754-6907
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Provider Business Mailing Address
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Address Line | 1337 BLUE SAGE WAY
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City | CHULA VISTA
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State | CA
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Zip | 91915-1616
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Country | US
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Telephone | 619-398-6990
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Fax | 619-754-6907
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARISSA AGATHA SHEPPARD
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Credential | OTRL
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Telephone | 619-398-6990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | B20030226685
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License Number State | CA
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