Provider Demographics
NPI:1902207681
Name:ZIMMERMAN, JOSEPH (PTA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30182 REGATTA BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6801
Mailing Address - Country:US
Mailing Address - Phone:717-805-5928
Mailing Address - Fax:
Practice Address - Street 1:30265 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-3593
Practice Address - Country:US
Practice Address - Phone:302-934-1783
Practice Address - Fax:302-934-1792
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000769225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant