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General NPI Number Information
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NPI Number | 1861622474
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY & REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 764 CAMPBELL AVE SUITE H
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City | WEST HAVEN
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State | CT
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Zip | 06516-3786
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Country | US
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Telephone | 203-909-6470
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Fax | 203-909-6471
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Provider Business Mailing Address
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Address Line | 2543 DIXWELL AVE
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City | HAMDEN
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State | CT
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Zip | 06514-1860
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Country | US
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Telephone | 203-287-9950
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Fax | 203-287-1232
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Authorized Official
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Title or Position | OWNER
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Name | JOANNA ALEKSIEJUK
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Credential | RPT
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Telephone | 203-287-9950
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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 | 005370
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License Number State | CT
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