MEDICARE: HUNTSVILLE PHYSICAL MEDICINE INSTITUTE PA

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	363L00000X	Nurse Practitioner		TX
2	332B00000X	Durable Medical Equipment & Medical Supplies	K1707	TX
3	207QS0010X	Sports Medicine (Family Medicine) Physician	K1707	TX

General Provider Information

NPI Number	:	1689916330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTSVILLE PHYSICAL MEDICINE INSTITUTE PA

Provider Business Mailing Address
First Line	:	901 NORMAL PARK DR
Second Line	:	SUITE 201
City	:	HUNTSVILLE
State	:	TX
Zip	:	77320-3770
Country	:	US
Telephone Number	:	936-291-2111
Fax Number	:	936-291-0665

Provider Business Practice Location Address
First Line	:	901 NORMAL PARK DR
Second Line	:	SUITE 201
City	:	HUNTSVILLE
State	:	TX
Zip	:	77320-3770
Country	:	US
Telephone Number	:	936-291-2111
Fax Number	:	936-291-0665

Authorized Official
Title or Position	:	OWNER
Name	:	ISNARDO E TREMOR
Credential	:	MD
Telephone Number	:	936-291-2111

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	10/01/2013

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