Healthcare Provider Details

I. General information

NPI: 1679610646
Provider Name (Legal Business Name): TARA LYNN ZIMMERMAN ATC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL PARK DR
DOVER OH
44622-3204
US

IV. Provider business mailing address

2196 LODGE RD SW
SHERRODSVILLE OH
44675-9734
US

V. Phone/Fax

Practice location:
  • Phone: 330-602-0719
  • Fax:
Mailing address:
  • Phone: 330-735-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT . 001400
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33. 010846
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: