Provider Demographics
NPI:1285283556
Name:ZIMMERMAN, JOSEPH LEE (ATC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEE
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 N FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2517
Mailing Address - Country:US
Mailing Address - Phone:765-894-0259
Mailing Address - Fax:
Practice Address - Street 1:BALL STATE UNIVERSITY 2000 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-0001
Practice Address - Country:US
Practice Address - Phone:765-894-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001925A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer