Provider Demographics
NPI:1730445925
Name:ZIMMERLEE, SHAWN LANNY
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:LANNY
Last Name:ZIMMERLEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-9356
Mailing Address - Country:US
Mailing Address - Phone:715-965-2622
Mailing Address - Fax:
Practice Address - Street 1:720 E KING RD
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-1513
Practice Address - Country:US
Practice Address - Phone:715-965-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1826-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant