Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1699781435 |
---|---|
Provider Name | Philip Lawrence Imbody |
First Address | Bandera, TX 78003-3727 |
Second Address | Kerrville, TX 78028-5768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |