Individual
MR. MARY MARGARET IMBODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06377
OH
225200000X
Physical Therapy Assistant
2306602313
VA
Other
Enumeration date
02/09/2011
Last updated
02/09/2011
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