Provider Demographics
NPI:1912006313
Name:ZIMMERMAN, RYAN EDWARD (PT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EDWARD
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 1:9621 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1827
Mailing Address - Country:US
Mailing Address - Phone:443-846-7959
Mailing Address - Fax:
Practice Address - Street 1:5009 HONEYGO CENTER DR STE 209
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9842
Practice Address - Country:US
Practice Address - Phone:443-725-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD214722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic