Brian Scott Imler, A.T.,C/L

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL1714 Issued in FL

Practice address

3675 Winged Foot Cir
Green Cove Springs, FL 32043-8023

Phone

(904) 982-5762

Fax

(904) 529-6557

NPI assigned

Jul 27, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280188800000",
    "number": "1508170952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9539",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320060030",
            "telephone_number": "904-982-5762",
            "fax_number": "904-529-6557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3675 WINGED FOOT CIR",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320438023",
            "telephone_number": "904-982-5762",
            "fax_number": "904-529-6557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMLER",
        "first_name": "BRIAN",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "A.T.,C/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-27",
        "last_updated": "2010-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL1714",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT001093",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Green Cove Springs, FL
• Providers in Green Cove Springs, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.