Provider Demographics
NPI:1912223785
Name:ZIMMERMAN, RIAN EVERETT (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:RIAN
Middle Name:EVERETT
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 HERON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3924
Mailing Address - Country:US
Mailing Address - Phone:956-532-4089
Mailing Address - Fax:
Practice Address - Street 1:2101 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3506
Practice Address - Country:US
Practice Address - Phone:956-632-5148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT23762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer