Provider Demographics
NPI:1043854508
Name:ZIMMS, ALLISON LEA
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEA
Last Name:ZIMMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:POTLATCH
Mailing Address - State:ID
Mailing Address - Zip Code:83855-0218
Mailing Address - Country:US
Mailing Address - Phone:208-875-9395
Mailing Address - Fax:
Practice Address - Street 1:325 W PALOUSE RIVER DR
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-8956
Practice Address - Country:US
Practice Address - Phone:208-875-9395
Practice Address - Fax:208-759-7819
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAST-3941225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist