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General NPI Number Information
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NPI Number | 1912726332
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Entity Type | Individual
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Provider Name | KYLE SHUMEYKO PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1825 MACARTHUR BLVD NW
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City | ATLANTA
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State | GA
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Zip | 30318-2023
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Country | US
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Telephone | 770-268-5893
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 TOWN BLVD NE UNIT 2317
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3674
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Country | US
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Telephone | 678-357-5430
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | PT015880
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License Number State | GA
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