Healthcare Provider Details

I. General information

NPI: 1295698165
Provider Name (Legal Business Name): GARRETT IMES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PENNKNOLL RD
EVERETT PA
15537-6940
US

IV. Provider business mailing address

155 SUMMIT ST
EVERETT PA
15537-6169
US

V. Phone/Fax

Practice location:
  • Phone: 814-623-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI004971
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: