1578547410 NPI number — SIMMONS PHYSICAL THERAPY, INC.

Table of content: (NPI 1578547410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578547410 NPI number — SIMMONS PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
SIMMONS PHYSICAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578547410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
285 N EL CAMINO REAL
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-5383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-633-1345
Provider Business Mailing Address Fax Number:
760-633-1419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 N EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-5383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-633-1345
Provider Business Practice Location Address Fax Number:
760-633-1419
Provider Enumeration Date:
12/05/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIMMONS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
760-633-1345

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  PT11587 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PT11587 . This is a "P.T. STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".