Jennifer L Zimmer
Individual provider Active NPI Physical Therapist · Mokane, MO
NPI 1124174107 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124174107
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 108123 (MO)
- Practice address
- 10135 State Road C
Mokane, MO 65059-1213 - Phone
- (573) 676-5225
- NPI assigned
- Jan 25, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108123 | MO | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 108123 | MO | Yes |
Addresses
Primary practice location
10135 State Road C
Mokane, MO 65059-1213
Mailing address
10135 State Road C
Mokane, MO 65059-1213
Phone (573) 676-5225
Other providers in Mokane, MO
All providers in Mokane, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.