MEDICARE: DR. ROXANNE MAANUM ZILMER MSPT, DPT, OCS

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	PT-20705	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13556501	OTHER	CA	CAQH

General Provider Information

NPI Number	:	1073738332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROXANNE MAANUM ZILMER MSPT, DPT, OCS

Provider Business Mailing Address
First Line	:	26854 WESTVALE RD
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-4050
Country	:	US
Telephone Number	:	310-503-8518
Fax Number	:

Provider Business Practice Location Address
First Line	:	26854 WESTVALE RD
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-4050
Country	:	US
Telephone Number	:	310-503-8518
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/02/2015

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