MEDICARE: MR. BRENT ROGER ZIMMERMAN L.M.P.

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	225700000X	Massage Therapist	00022833	WA

General Provider Information

NPI Number	:	1154520088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRENT ROGER ZIMMERMAN L.M.P.

Provider Business Mailing Address
First Line	:	2148 N 63RD ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5447
Country	:	US
Telephone Number	:	206-322-8568
Fax Number	:

Provider Business Practice Location Address
First Line	:	2148 N 63RD ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5447
Country	:	US
Telephone Number	:	206-322-8568
Fax Number	:

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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