1306021084 NPI number — EMILY JEANETTE SIMS P.T.

Table of content: EMILY JEANETTE SIMS P.T. (NPI 1306021084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306021084 NPI number — EMILY JEANETTE SIMS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMS
Provider First Name:
EMILY
Provider Middle Name:
JEANETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
EMILY
Provider Other Middle Name:
JEANETTER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306021084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3676 PARKER BLVD
Provider Second Line Business Mailing Address:
P.O. BOX 9000
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81008-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-553-2200
Provider Business Mailing Address Fax Number:
719-553-2216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3676 PARKER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81008-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-553-2200
Provider Business Practice Location Address Fax Number:
719-553-2216
Provider Enumeration Date:
12/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PTL0011937 . This is a "STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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