Provider Demographics
NPI:1215728316
Name:ZIMMERMAN, CARTER DAVID (CSCS,)
Entity type:Individual
Prefix:
First Name:CARTER
Middle Name:DAVID
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:CSCS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GLENBURN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS GREEN
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2515
Mailing Address - Country:US
Mailing Address - Phone:570-862-5316
Mailing Address - Fax:
Practice Address - Street 1:115 GLENBURN RD
Practice Address - Street 2:
Practice Address - City:CLARKS GREEN
Practice Address - State:PA
Practice Address - Zip Code:18411-2515
Practice Address - Country:US
Practice Address - Phone:570-862-5316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer