Individual
KELLY ZIMMERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
510 W 49TH ST, INDIANAPOLIS, IN 46208-3480
(317) 940-8437
Mailing address
510 W 49TH ST, INDIANAPOLIS, IN 46208-3480
(317) 940-8437
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002041A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000003809
BOARD OF CERTIFICATION, INC.
—
01
—
36002041A
INDIANA PROFESSIONAL LICENSURE -ATHLETIC TRAINER BOARD
IN
Enumeration date
03/19/2020
Last updated
03/19/2020
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