Basic Information
Provider Information
NPI: 1003144759
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZIMMER
FirstName: ARIEL
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: L.M.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 773 SW WASHINGTON ST
Address2:  
City: DALLAS
State: OR
PostalCode: 973383413
CountryCode: US
TelephoneNumber: 5415437366
FaxNumber:  
Practice Location
Address1: 220 KNOX ST N
Address2:  
City: MONMOUTH
State: OR
PostalCode: 973611431
CountryCode: US
TelephoneNumber: 5415437366
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/18/2009
LastUpdateDate: 02/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225700000X16454ORY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


Home