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General NPI Number Information
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NPI Number | 1902168420
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL RESTORATION PSC
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | E22 CALLE SANTA CRUZ
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City | BAYAMON
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State | PR
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Zip | 00961-6905
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Country | US
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Telephone | 787-782-2436
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Fax | 787-782-2430
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Provider Business Mailing Address
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Address Line | 50 CALLE BRAZIL STE 3 GARDENVILLE
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City | GUAYNABO
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State | PR
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Zip | 00966-2037
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Country | US
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Telephone | 787-782-2436
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Fax | 787-782-2430
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PEREZ ALEJANDRO
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Credential | M.D.,M.P.H.,DABPMR
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Telephone | 787-782-2436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State | PR
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