Provider Demographics
NPI:1083961585
Name:ZIMAN, MEGAN A (PT,DPT,ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:ZIMAN
Suffix:
Gender:F
Credentials:PT,DPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-7330
Mailing Address - Country:US
Mailing Address - Phone:630-469-7858
Mailing Address - Fax:
Practice Address - Street 1:875 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6101
Practice Address - Country:US
Practice Address - Phone:630-469-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019323225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer