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General NPI Number Information
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NPI Number | 1992432231
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Entity Type | Organization
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Legal Business Name | ELITE THERAPY AND WELLNESS PSL LLC
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 5483 NW SAINT JAMES DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-3444
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Country | US
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Telephone | 561-320-9302
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Fax | 561-320-9305
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Provider Business Mailing Address
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Address Line | 2151 S ALTERNATE A1A STE 650
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City | JUPITER
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State | FL
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Zip | 33477-4097
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Country | US
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Telephone | 561-320-9302
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Fax | 561-320-9305
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AMY SMITH
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Credential |
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Telephone | 561-320-9302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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