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13085 Telecom Pkwy N. Temple Terrace, FL 33637 Phone: 8139777999 | Fax: 8139777444 Email: SIS@stayinstep.orgPHYSICAL THERAPY PRESCRIPTION FORM Patient Last Name: ___ ___First Name: ___Middle: ___

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Stay in stepbrain and refers to the form or process used to request a temporary pause in a project or activity.

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