MEDICARE: MR. BRIAN KEITH PAHLMANN PTA, ATC

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
1	225200000X	Physical Therapy Assistant	2058259	TX
2	225200000X	Physical Therapy Assistant	2000172010	MO
3	2255A2300X	Athletic Trainer	2001007778	MO
4	225200000X	Physical Therapy Assistant		IL

General Provider Information

NPI Number	:	1659349108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN KEITH PAHLMANN PTA, ATC

Provider Business Mailing Address
First Line	:	2924 WHEWELL AVE
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-3659
Country	:	US
Telephone Number	:	217-223-3063
Fax Number	:

Provider Business Practice Location Address
First Line	:	6360 W SAM HOUSTON PKWY N
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77041-5164
Country	:	US
Telephone Number	:	713-280-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/31/2007

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