Basic Information
Provider Information | |||||||||
NPI: | 1487669909 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZIMBELMAN | ||||||||
FirstName: | ANNE | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 73 NEWTON RD | ||||||||
Address2: | STE 101 | ||||||||
City: | PLAISTOW | ||||||||
State: | NH | ||||||||
PostalCode: | 038652424 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9783887272 | ||||||||
FaxNumber: | 9783887373 | ||||||||
Practice Location | |||||||||
Address1: | 1350 SULLIVAN AVE | ||||||||
Address2: |   | ||||||||
City: | SOUTH WINDSOR | ||||||||
State: | CT | ||||||||
PostalCode: | 060742760 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8606976472 | ||||||||
FaxNumber: | 8606482876 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2006 | ||||||||
LastUpdateDate: | 06/25/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7403 | CT | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 080007403CT01 | 01 | CT | BLUE CROSS BLUE SHEILD | OTHER | 004247301 | 05 | CT |   | MEDICAID |