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General NPI Number Information
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NPI Number | 1932386448
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Entity Type | Organization
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Legal Business Name | ELITE PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 30941 MILL LANE SUITE D
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City | DAPHNE
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State | AL
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Zip | 36526
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Country | US
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Telephone | 251-533-3275
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7627
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City | MOBILE
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State | AL
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Zip | 36670-0627
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Country | US
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Telephone | 251-625-2170
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Fax | 251-625-2172
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMBERLY C MASON
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Credential | PT
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Telephone | 251-425-2170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | PTH4377
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License Number State | AL
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