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General NPI Number Information
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NPI Number | 1962885111
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Entity Type | Organization
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Legal Business Name | OPTIMA THERAPY SERVICES CORP.
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 621 WASHINGTON ST SW SUITE B1
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City | GAINESVILLE
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State | GA
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Zip | 30501-8567
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Country | US
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Telephone | 678-936-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 790 PARK ST
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City | GAINESVILLE
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State | GA
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Zip | 30501-3417
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Country | US
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Telephone | 678-936-3535
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. JOSHUA E. STEFANOFF
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Credential |
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Telephone | 678-936-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OT004965
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License Number State | GA
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