Healthcare Provider Details

I. General information

NPI: 1932029055
Provider Name (Legal Business Name): RAQUEL IMLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 FRONT ST
SAXTON PA
16678-8610
US

IV. Provider business mailing address

1016 EGOLF RD
BEDFORD PA
15522-5110
US

V. Phone/Fax

Practice location:
  • Phone: 814-635-2975
  • Fax:
Mailing address:
  • Phone: 814-494-8545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT008808
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: