Provider Demographics
NPI:1144712423
Name:ZIMMERMAN, MICHAEL TAYLOR I (CP BOCOP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TAYLOR
Last Name:ZIMMERMAN
Suffix:I
Gender:M
Credentials:CP BOCOP
Other - Prefix:
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Mailing Address - Street 1:121 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-9207
Mailing Address - Country:US
Mailing Address - Phone:724-875-5334
Mailing Address - Fax:412-372-7830
Practice Address - Street 1:4280 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-1614
Practice Address - Country:US
Practice Address - Phone:412-622-2020
Practice Address - Fax:412-372-7830
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOH000039222Z00000X
PAPO000019224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist