Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01892600 | NJ |
N | 2251P0200X | Physical Therapist - Pediatrics | 40QA01892600 | NJ |
N | 2251S0007X | Physical Therapist - Sports | 40QA01892600 | NJ |
N | 2251X0800X | Physical Therapist - Orthopedic | 40QA01892600 | NJ |
NPI | 1366083503 |
---|---|
Provider Name | Laura Zimmermann |
First Address | Mullica Hill, NJ 08062-1800 |
Second Address | Mullica Hill, NJ 08062-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2019 |
Last Update Date | 30/09/2019 |