Provider Demographics
NPI:1841640935
Name:ZIMMERMAN, MINDY L (CMT, CLT, BCTMB)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:L
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:CMT, CLT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SAN CLEMENTE DR
Mailing Address - Street 2:SUITE D100A
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1244
Mailing Address - Country:US
Mailing Address - Phone:415-450-5345
Mailing Address - Fax:
Practice Address - Street 1:45 SAN CLEMENTE DR
Practice Address - Street 2:SUITE D100A
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1244
Practice Address - Country:US
Practice Address - Phone:415-450-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14813225700000X
CA448245-00225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist