Basic Information
| Provider Information | |||||||||
| NPI: | 1588253876 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ZIMMERMAN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5800 LONETREE BLVD STE 101 | ||||||||
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| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957653785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163029200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 180 STATE ST STE 225 | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760927632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668396979 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2021 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1156576 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.