Provider Demographics
NPI:1194024067
Name:ZIMMER, CHRISTINE MAE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MAE
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:ONTONAGON
Mailing Address - State:MI
Mailing Address - Zip Code:49953-1344
Mailing Address - Country:US
Mailing Address - Phone:906-884-2354
Mailing Address - Fax:
Practice Address - Street 1:634 E AYER ST
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-2206
Practice Address - Country:US
Practice Address - Phone:906-932-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000988225200000X
WI1673-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant