Provider Demographics
NPI:1447257761
Name:ZIMMER, CAMERON L (PT)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:L
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 PENSEL RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9426
Mailing Address - Country:US
Mailing Address - Phone:410-615-2424
Mailing Address - Fax:
Practice Address - Street 1:4409 PENSEL RD
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9426
Practice Address - Country:US
Practice Address - Phone:410-615-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20970225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD074737800Medicaid
MD3115837OtherMAMSI
MDH370H125Medicare PIN