Healthcare Provider Details

I. General information

NPI: 1346276714
Provider Name (Legal Business Name): JERRY L ZOMERMAAND P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 S MAIN AVE
SIOUX CENTER IA
51250-1230
US

IV. Provider business mailing address

PO BOX 274
SIOUX CENTER IA
51250-0274
US

V. Phone/Fax

Practice location:
  • Phone: 712-722-0055
  • Fax: 712-722-0059
Mailing address:
  • Phone: 712-722-0055
  • Fax: 712-722-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number02048
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: