Provider Demographics
NPI:1932316940
Name:HIMMELMAN, MICHAEL T (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:HIMMELMAN
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:2725 N WESTWOOD BLVD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2346
Mailing Address - Country:US
Mailing Address - Phone:573-686-4277
Mailing Address - Fax:573-686-4406
Practice Address - Street 1:225 PHYSICIANS PARK
Practice Address - Street 2:SUITE 101
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3956
Practice Address - Country:US
Practice Address - Phone:573-778-9348
Practice Address - Fax:573-686-4870
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2013-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARPT2966225100000X, 2251S0007X, 2251X0800X
MO2011037087225100000X
20110370872251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164036721Medicaid