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General NPI Number Information
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NPI Number | 1861493355
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Entity Type | Organization
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Legal Business Name | AMERICAN MEDICAL REHAB, INC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 4545 SAINT AUGUSTINE RD 2
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City | JACKSONVILLE
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State | FL
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Zip | 32207-7229
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Country | US
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Telephone | 904-731-0110
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Fax | 904-731-0121
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Provider Business Mailing Address
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Address Line | 4545-2 ST. AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32207
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Country | US
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Telephone | 904-731-0110
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Fax | 904-731-0121
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LESIA AMANDA OWENSBY
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Credential |
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Telephone | 904-731-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 12536000002
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License Number State | FL
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