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General NPI Number Information
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NPI Number | 1841592136
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Entity Type | Individual
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Provider Name | ANGELA S LEE MSPT
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Gender | Female
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 1615 SW OCEAN COVE AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2561
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Country | US
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Telephone | 954-579-5619
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Fax | 772-673-0523
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Provider Business Mailing Address
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Address Line | 1615 SW OCEAN COVE AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2561
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Country | US
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Telephone | 954-579-5619
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Fax | 772-673-0523
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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 | PT25101
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License Number State | FL
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