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General NPI Number Information
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NPI Number | 1841863958
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Entity Type | Individual
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Provider Name | GINA KELLY-ELLIOTT DPT
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Gender | Female
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 12800 MISSISSIPPI PKWY
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City | CROWN POINT
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State | IN
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Zip | 46307-6900
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Country | US
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Telephone | 219-662-5770
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Fax |
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Provider Business Mailing Address
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Address Line | 319 E MORGAN AVE
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City | CHESTERTON
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State | IN
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Zip | 46304-2520
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Country | US
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Telephone | 773-414-4397
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05011844A
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License Number State | IN
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