Provider Demographics
NPI:1699781435
Name:IMBODY, PHILIP LAWRENCE (KINESIOTHERAPIST)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:LAWRENCE
Last Name:IMBODY
Suffix:
Gender:M
Credentials:KINESIOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 FOREST TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-3727
Mailing Address - Country:US
Mailing Address - Phone:830-796-3601
Mailing Address - Fax:
Practice Address - Street 1:3600 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5768
Practice Address - Country:US
Practice Address - Phone:830-896-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist