Provider Demographics
NPI:1265422711
Name:ZIMNEY, JEREMY J (PT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:J
Last Name:ZIMNEY
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 1:1112 W 6TH ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2215
Mailing Address - Country:US
Mailing Address - Phone:785-843-9125
Mailing Address - Fax:785-843-6973
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:SUITE 124
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:785-843-6973
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100384510CMedicaid
KS004234002Medicare PIN