Provider Demographics
NPI:1073738332
Name:ZILMER, ROXANNE MAANUM (MSPT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:MAANUM
Last Name:ZILMER
Suffix:
Gender:F
Credentials:MSPT, DPT, OCS
Other - Prefix:MISS
Other - First Name:ROXANNE
Other - Middle Name:LEE
Other - Last Name:MAANUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:26854 WESTVALE RD
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-4050
Mailing Address - Country:US
Mailing Address - Phone:310-503-8518
Mailing Address - Fax:
Practice Address - Street 1:26854 WESTVALE RD
Practice Address - Street 2:
Practice Address - City:PALOS VERDES PENINSULA
Practice Address - State:CA
Practice Address - Zip Code:90274-4050
Practice Address - Country:US
Practice Address - Phone:310-503-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT-20705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13556501OtherCAQH