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General NPI Number Information
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NPI Number | 1902935075
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Entity Type | Organization
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Legal Business Name | OMNI REHAB & THERAPY CENTER
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1642 E WASHINGTON ST
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City | COLTON
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State | CA
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Zip | 92324-4605
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Country | US
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Telephone | 909-370-0611
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Fax | 909-370-0612
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Provider Business Mailing Address
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Address Line | 1642 E WASHINGTON ST
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City | COLTON
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State | CA
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Zip | 92324-4605
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Country | US
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Telephone | 909-370-0611
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Fax | 909-370-0612
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Authorized Official
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Title or Position | OWNER
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Name | FLORA MOHAMED SHAFIEE
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Credential | DPTS
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Telephone | 909-370-0611
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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 | PT17474
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License Number State | CA
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