1679643936 NPI number — MR. THOMAS CURTIS SIMMONS R.P.T.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679643936 NPI number — MR. THOMAS CURTIS SIMMONS R.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMONS
Provider First Name:
THOMAS
Provider Middle Name:
CURTIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.P.T.
Provider Gender Code:
M

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:
1679643936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2019
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:
STE 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:
201 S EL CAMINO REAL STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-4150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-274-1671
Provider Business Practice Location Address Fax Number:
760-274-1678
Provider Enumeration Date:
11/08/2006

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 , 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 "RPT LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1578547410 . This is a "NPI FOR CORPORATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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