Healthcare Provider Details

I. General information

NPI: 1962036152
Provider Name (Legal Business Name): EMILIA ZIMMERMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FISHER POND RD
SAINT ALBANS VT
05478-6286
US

IV. Provider business mailing address

107 FISHER POND RD
SAINT ALBANS VT
05478-6286
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-6554
  • Fax:
Mailing address:
  • Phone: 413-323-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16434
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0136786
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: