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General NPI Number Information
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NPI Number | 1841884814
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Entity Type | Individual
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Provider Name | JOEL HARRIS MS, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 02/21/2021
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Last Update Date | 02/21/2021
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Provider Practice Location Address
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Address Line | 11500 FENWAY SOUTH DR
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City | FORT MYERS
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State | FL
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Zip | 33913-8671
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Country | US
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Telephone | 213-395-8896
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Fax |
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Provider Business Mailing Address
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Address Line | 12020 ROCK BROOK RUN APT 1804
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City | FORT MYERS
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State | FL
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Zip | 33913-6811
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Country | US
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Telephone | 802-299-6326
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | AL4767
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License Number State | FL
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