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General NPI Number Information
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NPI Number | 1831506419
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Entity Type | Organization
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Legal Business Name | PRO CARE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 9860 S ESTRELLA PKWY # B-105
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City | GOODYEAR
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State | AZ
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Zip | 85338-7149
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Country | US
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Telephone | 623-594-5473
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Fax | 623-594-5479
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Provider Business Mailing Address
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Address Line | 9860 S ESTRELLA PKWY # B-105
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City | GOODYEAR
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State | AZ
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Zip | 85338-7149
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Country | US
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Telephone | 623-594-5473
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Fax | 623-594-5479
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LAWRENCE SHAUF
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Credential | P.T.
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Telephone | 623-594-5473
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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 | 10051
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License Number State | AZ
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