MEDICARE: LYNNE ZIMMERMAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2434	MN

General Provider Information

NPI Number	:	1902802119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNE ZIMMERMAN PT

Provider Business Mailing Address
First Line	:	724 19TH AVE N
Second Line	:	# 100
City	:	SOUTH SAINT PAUL
State	:	MN
Zip	:	55075-1301
Country	:	US
Telephone Number	:	651-552-0288
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 19TH AVE N
Second Line	:	# 100
City	:	SOUTH SAINT PAUL
State	:	MN
Zip	:	55075-1301
Country	:	US
Telephone Number	:	651-552-0288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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