Provider Demographics
NPI:1841785664
Name:ZIMMERMAN, CAMERON (PT)
Entity Type:Individual
Prefix:
First Name:CAMERON
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 1:8740 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-8705
Mailing Address - Country:US
Mailing Address - Phone:913-942-5090
Mailing Address - Fax:913-942-5095
Practice Address - Street 1:8740 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-8705
Practice Address - Country:US
Practice Address - Phone:913-942-5090
Practice Address - Fax:913-942-5095
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist