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General NPI Number Information
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NPI Number | 1952767907
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Entity Type | Organization
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Legal Business Name | PRO ACTIVE WELLNESS AND INJURY CENTER
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 1200 S COL ROWE BLVD
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City | MCALLEN
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State | TX
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Zip | 78501-2956
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Country | US
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Telephone | 956-429-3082
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Fax | 956-800-4476
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Provider Business Mailing Address
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Address Line | 1200 S COL ROWE BLVD
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City | MCALLEN
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State | TX
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Zip | 78501-2956
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Country | US
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Telephone | 956-429-3082
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Fax | 956-800-4476
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAFATH QURAISHI
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Credential | M.D.
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Telephone | 956-994-1752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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