Provider Demographics
NPI:1063128312
Name:ZIMMERMAN, ANN MARIE (LMT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35067 CURRIER ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2347
Mailing Address - Country:US
Mailing Address - Phone:313-605-0821
Mailing Address - Fax:
Practice Address - Street 1:35425 W MICHIGAN AVE STE 3625
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1600
Practice Address - Country:US
Practice Address - Phone:313-605-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000780225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7501000780OtherSTATE OF MICHIGAN