Provider Demographics
NPI:1568456556
Name:ZIMMERMAN, EDWARD D (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
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 1:100 ALMSHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1108
Mailing Address - Country:US
Mailing Address - Phone:215-357-2000
Mailing Address - Fax:215-357-8499
Practice Address - Street 1:100 ALMSHOUSE RD
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1108
Practice Address - Country:US
Practice Address - Phone:215-357-2000
Practice Address - Fax:215-357-8499
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA007019L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA733283OtherPA BLUE SHIELD
PA733283OtherPA BLUE SHIELD