MEDICARE: VICKIE LYNN IMLER MSPT

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	2251X0800X	Orthopedic Physical Therapist	1118032	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1118032	OTHER	TX	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1578673950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKIE LYNN IMLER MSPT

Provider Business Mailing Address
First Line	:	1502 PECH RD APT 14
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3382
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9180 OLD KATY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7454
Country	:	US
Telephone Number	:	713-984-1400
Fax Number	:	713-647-8090

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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