Basic Information
| Provider Information | |||||||||
| NPI: | 1265422711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMNEY | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 W 6TH ST | ||||||||
| Address2: | SUITE 124 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660442215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439125 | ||||||||
| FaxNumber: | 7858436973 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 W 6TH ST | ||||||||
| Address2: | SUITE 124 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660442215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439125 | ||||||||
| FaxNumber: | 7858436973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 03/31/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1102976 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 100384510C | 05 | KS | MEDICAID |