Provider Demographics
NPI:1679610646
Name:ZIMMERMAN, TARA LYNN (ATC, LMT)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2196 LODGE RD SW
Mailing Address - Street 2:
Mailing Address - City:SHERRODSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44675-9734
Mailing Address - Country:US
Mailing Address - Phone:330-735-1081
Mailing Address - Fax:
Practice Address - Street 1:500 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3204
Practice Address - Country:US
Practice Address - Phone:330-602-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT . 0014002255A2300X
OH33. 010846225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist