Provider Demographics
NPI:1649706813
Name:ZIMMERMAN, RIZA GRACE ROBLES
Entity type:Individual
Prefix:
First Name:RIZA GRACE
Middle Name:ROBLES
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3843
Mailing Address - Country:US
Mailing Address - Phone:757-547-5145
Mailing Address - Fax:757-312-0216
Practice Address - Street 1:501 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3843
Practice Address - Country:US
Practice Address - Phone:757-842-7010
Practice Address - Fax:757-436-2480
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist