Provider Demographics
NPI:1891229258
Name:ZIMMERMAN, MINDY
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 TAYLOR JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8597
Mailing Address - Country:US
Mailing Address - Phone:330-697-9728
Mailing Address - Fax:
Practice Address - Street 1:12234 COOPERS RUN
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-9238
Practice Address - Country:US
Practice Address - Phone:440-572-2737
Practice Address - Fax:440-398-0414
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist