Provider Demographics
NPI:1770345621
Name:ZIMMER, CASSANDRA K
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:K
Last Name:ZIMMER
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 1:2341 LOWER WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:AR
Mailing Address - Zip Code:72958-8600
Mailing Address - Country:US
Mailing Address - Phone:479-207-0124
Mailing Address - Fax:
Practice Address - Street 1:2341 LOWER WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958-8600
Practice Address - Country:US
Practice Address - Phone:479-207-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2136225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant