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General NPI Number Information
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NPI Number | 1821375155
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Entity Type | Individual
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Provider Name | STACIE R BROWN
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Gender | Female
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 01/29/2012
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Provider Practice Location Address
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Address Line | 2505 SE MILE HILL DR SUITE B-23
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City | PORT ORCHARD
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State | WA
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Zip | 98366-3521
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Country | US
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Telephone | 360-633-6735
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 SE WINDSOR CT
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City | PORT ORCHARD
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State | WA
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Zip | 98366-5850
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Country | US
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Telephone | 360-633-6735
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA 60255070
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License Number State | WA
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