Provider Demographics
NPI:1053676551
Name:ZUCNICK-KIMBUGWE, JESSIE LEE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:LEE
Last Name:ZUCNICK-KIMBUGWE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 FORCE DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-2302
Mailing Address - Country:US
Mailing Address - Phone:256-372-8458
Mailing Address - Fax:256-372-8480
Practice Address - Street 1:4900 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:AL
Practice Address - Zip Code:35762
Practice Address - Country:US
Practice Address - Phone:256-372-8458
Practice Address - Fax:256-372-8480
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer