Provider Demographics
NPI:1265491609
Name:ZIMMERMAN, LORI (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W SAM HOUSTON PKWY S STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2453
Mailing Address - Country:US
Mailing Address - Phone:713-297-6792
Mailing Address - Fax:713-430-4041
Practice Address - Street 1:770 GAUSE BLVD STE F
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2855
Practice Address - Country:US
Practice Address - Phone:985-649-9123
Practice Address - Fax:985-649-9129
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0776225100000X
LALA00776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
196620Medicare ID - Type Unspecified