MEDICARE: PAMELA LYNN WIMBERLEY PT

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	225100000X	Physical Therapist	3028	OK

General Provider Information

NPI Number	:	1437191319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LYNN WIMBERLEY PT

Provider Business Mailing Address
First Line	:	1514 W HALL OF FAME
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-0001
Country	:	US
Telephone Number	:	405-744-7414
Fax Number	:	405-744-8448

Provider Business Practice Location Address
First Line	:	1514 W HALL OF FAME
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-0001
Country	:	US
Telephone Number	:	405-744-7414
Fax Number	:	405-744-8448

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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