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General NPI Number Information
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NPI Number | 1982317228
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Entity Type | Individual
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Provider Name | IDA KOLODZIEJCZYK
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Gender | Female
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 352 E HOOD AVE STE D
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City | SISTERS
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State | OR
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Zip | 97759-1619
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Country | US
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Telephone | 541-904-4427
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 SW CHANDLER AVE STE 103
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City | BEND
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State | OR
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Zip | 97702-3208
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Country | US
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Telephone | 541-797-3052
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 64740
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License Number State | OR
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