Provider Demographics
NPI:1346674405
Name:DICHARRY, DAPHNE ZIMMER (PT)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:ZIMMER
Last Name:DICHARRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:MICHELE
Other - Last Name:ZIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8080 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-924-2424
Mailing Address - Fax:225-408-7984
Practice Address - Street 1:625 S BURNSIDE AVE
Practice Address - Street 2:UNIT 9
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3400
Practice Address - Country:US
Practice Address - Phone:225-644-8510
Practice Address - Fax:225-644-9736
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist