Provider Demographics
NPI:1003144759
Name:ZIMMER, ARIEL (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 SW WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-3413
Mailing Address - Country:US
Mailing Address - Phone:541-543-7366
Mailing Address - Fax:
Practice Address - Street 1:128 SE MILL ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1908
Practice Address - Country:US
Practice Address - Phone:541-543-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16454225700000X
WAMA 60118147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist