Provider Demographics
NPI:1861825077
Name:ZIMMERMAN, JESSICA S (PT)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:S
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2831 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1320
Mailing Address - Country:US
Mailing Address - Phone:270-926-4100
Mailing Address - Fax:
Practice Address - Street 1:2831 NEW HARTFORD RD
Practice Address - Street 2:RIDGECREST MEDICAL PARK
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-926-4100
Practice Address - Fax:270-684-4678
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305207933OtherVIRGINIA STATE LICENSE NUMBER