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General NPI Number Information
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NPI Number | 1932392388
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Entity Type | Individual
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Provider Name | BRENDA BERNICE HARVEY P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 3200 MISSION ARCH DR
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City | ROSWELL
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State | NM
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Zip | 88201-8307
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Country | US
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Telephone | 509-945-4868
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 76
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City | ALLISON
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State | TX
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Zip | 79003-0076
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Country | US
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Telephone | 509-945-4868
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-0538
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License Number State | NM
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