Provider Demographics
NPI:1629212402
Name:ZIMMERMANN, DONNA (PT3313)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:PT3313
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:ZIMMERMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT3313
Mailing Address - Street 1:8455 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5066
Mailing Address - Country:US
Mailing Address - Phone:812-684-4500
Mailing Address - Fax:813-684-0411
Practice Address - Street 1:519 E BLOOMINGDALE AVE STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8180
Practice Address - Country:US
Practice Address - Phone:813-684-4500
Practice Address - Fax:813-684-0411
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106898OtherMEDICARE ID