Basic Information
| Provider Information | |||||||||
| NPI: | 1164406161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMNEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | MPT GCG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 LEFFELLE ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973022949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035108869 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1380 LIBERTY ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973024246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033710779 | ||||||||
| FaxNumber: | 5033710886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251G0304X | 4064 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
ID Information
| ID | Type | State | Issuer | Description | 277941 | 05 | OR | MEDICAID |