Provider Demographics
NPI:1326523861
Name:ZIMMERMAN, COLLIN D (DPT)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:D
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 NORTHWEST BLVD.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5605
Mailing Address - Country:US
Mailing Address - Phone:208-667-6264
Mailing Address - Fax:208-664-4313
Practice Address - Street 1:1088 W. PRAIRIE AVE.
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8741
Practice Address - Country:US
Practice Address - Phone:208-772-6609
Practice Address - Fax:208-664-4313
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-5983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT-5983OtherSTATE OF IDAHO