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NPI Code Detail

MEDICARE: MR. RICHARD ALLEN IMHOFF RPT

MEDICARE: MR. RICHARD ALLEN IMHOFF RPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT23771FL

General Provider Information

NPI Number : 1154682193
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD ALLEN IMHOFF RPT
Provider Business Mailing Address
First Line : 1931 MARTIN LUTHER KING JR BLVD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-5314
Country : US
Telephone Number : 850-215-7093
Fax Number : 850-215-7096
Provider Business Practice Location Address
First Line : 1931 MARTIN LUTHER KING JR BLVD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-5314
Country : US
Telephone Number : 850-215-7093
Fax Number : 850-215-7096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2012
Last Update Date : 06/06/2012

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