Provider Demographics
NPI:1679679344
Name:ZIMMERMAN, PENNY A (PT)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 VILLANOVA AVE
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-2614
Mailing Address - Country:US
Mailing Address - Phone:610-544-8358
Mailing Address - Fax:
Practice Address - Street 1:828 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4526
Practice Address - Country:US
Practice Address - Phone:610-344-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009571-L225100000X
NJ40QA01014400225100000X
DCPT870594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028419UV9Medicare ID - Type Unspecified