Healthcare Provider Details

I. General information

NPI: 1366956187
Provider Name (Legal Business Name): SARAH ZIMMER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 CANYON BLVD STE 150
BOULDER CO
80302-6737
US

IV. Provider business mailing address

2595 CANYON BLVD STE 150
BOULDER CO
80302-6737
US

V. Phone/Fax

Practice location:
  • Phone: 262-914-2307
  • Fax:
Mailing address:
  • Phone: 262-914-2307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0014746
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier665892
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerMCR PTAN
# 2
Identifier665892
Identifier TypeOTHER
Identifier State
Identifier IssuerMCR PTAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: