Provider Demographics
NPI:1790076206
Name:ZIMMERMAN, KIM ELAINE (LMT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ELAINE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 AVENUE F NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4133
Mailing Address - Country:US
Mailing Address - Phone:863-221-3702
Mailing Address - Fax:863-298-8075
Practice Address - Street 1:150 AVENUE F NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4133
Practice Address - Country:US
Practice Address - Phone:863-221-3702
Practice Address - Fax:863-298-8075
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 37857225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist