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General NPI Number Information
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NPI Number | 1992210223
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Entity Type | Organization
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Legal Business Name | THERAFIT PHYSICAL THERAPY, LLC.
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 2008 RIVERSIDE AVE STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4459
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Country | US
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Telephone | 904-868-9268
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Fax |
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Provider Business Mailing Address
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Address Line | 1755 MAYVIEW RD
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City | JACKSONVILLE
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State | FL
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Zip | 32210-2219
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Country | US
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Telephone | 904-868-9268
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STEPHANIE AMBRIDGE WILKINSON
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Credential | MPT
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Telephone | 904-868-9268
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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 |
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License Number State | FL
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