Mary Margaret Imboden

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

06377 Issued in OH

Practice address

31825 Bayview Dr
Townhome # 112
Avon Lake, OH 44012-2485

Phone

(440) 476-6766

NPI assigned

Feb 9, 2011

Sex

Female

Sole proprietor

No

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": "1297209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297209600000",
    "number": "1730485681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31825 BAYVIEW DR",
            "address_2": "TOWNHOME # 112",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "440122485",
            "telephone_number": "440-476-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31825 BAYVIEW DR",
            "address_2": "TOWNHOME # 112",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "440122485",
            "telephone_number": "440-476-6766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMBODEN",
        "first_name": "MARY",
        "middle_name": "MARGARET",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-09",
        "last_updated": "2011-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OH",
            "license": "06377",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306602313",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlene Hogue, LISW
• Michael Holland, LMT
• Lillian Leora Houston, LPN
• Colleen M Hoy, COTA/L
• Mikayla Brooke Hyland
• Independence Village Avon Lake LLC.
• Intrasync Solutions, Inc.
• Paula Jacobson, LISW-S
• Jeanne M James, LPN
• Carol Maddox Jaworski, M.S., CCC-SLP

• Physical Therapy Assistant in Avon Lake, OH
• Providers in Avon Lake, OH by specialty
• Physical Therapy Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; 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.