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Get PSF-750 2009

Rral issued (if applicable) Zip code Group number Referral number (if applicable) Provider Information 1. Name of the billing provider or facility (as it will appear on the claim form) 2. Federal tax ID(TIN) of entity in box #1 1 MD/DO 2 4 OT 5 Both PT and OT 6 Home Care 7 ATC DC 3 PT 8 MT 9 Other 3. Name and credentials of the individual performing the service(s) 4. Alternate name (if any) of entity in box #1 6. Phone number 5. NPI of entity in box #1 8. City 7. Address of the .

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Keywords relevant to PSF-750

  • icd
  • npi
  • Labral
  • CMT
  • ACL
  • INTERMITTENTLY
  • unspecified
  • recurrent
  • applicable
  • Rotator
  • selections
  • referral
  • repetitive
  • Tendon
  • moderately
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