Provider Demographics
NPI:1386990786
Name:IMKER, PATRICIA D (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:IMKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:D
Other - Last Name:MANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7551 9TH ST N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6629
Mailing Address - Country:US
Mailing Address - Phone:651-747-4328
Mailing Address - Fax:
Practice Address - Street 1:433 MENDOTA RD E
Practice Address - Street 2:
Practice Address - City:W ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-5104
Practice Address - Country:US
Practice Address - Phone:651-552-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist