Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 4064 | OR |
NPI | 1164406161 |
---|---|
Provider Name | Jennifer Lynne Zimney |
First Address | Salem, OR 97302-2949 |
Second Address | Salem, OR 97302-4246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
277941 | (05) | OR |
Q40454 | (02) |