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General NPI Number Information
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NPI Number | 1942796529
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Entity Type | Individual
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Provider Name | ROSHELLE VENEGAS BALISI PTA
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Gender | Female
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 2226 LILIHA ST STE 304
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City | HONOLULU
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State | HI
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Zip | 96817-1605
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Country | US
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Telephone | 808-547-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 94-790 KAAKA ST
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City | WAIPAHU
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State | HI
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Zip | 96797-1298
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Country | US
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Telephone | 808-225-8604
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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 | 298
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License Number State | HI
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