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General NPI Number Information
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NPI Number | 1912280447
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Entity Type | Individual
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Provider Name | CHIYE ONODERA DUFFY MPT, C/NDT, CIMI
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Gender | Female
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 900 N SWALLOW TAIL DR STE 107
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City | PORT ORANGE
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State | FL
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Zip | 32129-6103
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Country | US
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Telephone | 386-446-9935
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Fax | 386-446-7777
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Provider Business Mailing Address
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Address Line | 5558 W. BAYSHORE DRIVE
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City | PORT ORANGE
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State | FL
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Zip | 32127-6116
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Country | US
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Telephone | 949-256-6918
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT 20885
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT 29683
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License Number State | FL
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