Provider Demographics
NPI:1417272220
Name:ZIMMERMAN, WAYNE (PT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SAWGRASS WAY APT 3113
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-3379
Mailing Address - Country:US
Mailing Address - Phone:312-545-3217
Mailing Address - Fax:
Practice Address - Street 1:3800 SAWGRASS WAY APT 3113
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-3379
Practice Address - Country:US
Practice Address - Phone:312-545-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30915225100000X
IL070017043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist