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Individual
ELY PASTORAL
Active
Individual
ELY PASTORAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070014826
IL
225100000X
Physical Therapist
Primary
35994
CA
Other
Enumeration date
04/13/2017
Last updated
04/13/2017
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