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General NPI Number Information
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NPI Number | 1952805392
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Entity Type | Organization
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Legal Business Name | HYBRID PT, LLC
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 962 KINDERKAMACK RD
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2331
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Country | US
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Telephone | 201-429-3996
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Fax | 201-812-9604
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Provider Business Mailing Address
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Address Line | 962 KINDERKAMACK ROAD
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2331
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Country | US
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Telephone | 201-429-3996
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Fax | 201-812-9604
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Authorized Official
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Title or Position | OWNER
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Name | JAMES PARK
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Credential |
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Telephone | 201-429-3996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01252200
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License Number State | NJ
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