Provider Demographics
NPI:1215490305
Name:ZIMMERMAN, AMANDA NICOLE (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:NICOLE
Last Name:ZIMMERMAN
Suffix:
Gender:
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3901 CAPITAL MALL DR SW STE D
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8654
Mailing Address - Country:US
Mailing Address - Phone:360-709-6221
Mailing Address - Fax:360-359-4727
Practice Address - Street 1:3901 CAPITAL MALL DR SW STE D
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8654
Practice Address - Country:US
Practice Address - Phone:360-709-6221
Practice Address - Fax:360-359-4727
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5460225100000X
OR62947225100000X
TX1293179225100000X
NHCP006329T225100000X
WAPT613332312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist