Provider Demographics
NPI:1043828502
Name:ZIMARDO, DIANE MARILYN (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARILYN
Last Name:ZIMARDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 BANNISTER ST STE 4
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-4946
Mailing Address - Country:US
Mailing Address - Phone:717-812-5850
Mailing Address - Fax:
Practice Address - Street 1:1575 BANNISTER ST STE 4
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-4946
Practice Address - Country:US
Practice Address - Phone:717-812-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006292L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic