Provider Demographics
NPI:1073822219
Name:ZIMMERMAN, NICOLE EDWARDS (DPT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:EDWARDS
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:DEPARTMENT OF PT/OT
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-843-2164
Mailing Address - Fax:919-843-2195
Practice Address - Street 1:100 SPRUNT ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7811
Practice Address - Country:US
Practice Address - Phone:919-843-2164
Practice Address - Fax:919-843-2195
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020941225100000X
VA2305206953225100000X
NCP14839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ36478AMedicare PIN