Basic Information
| Provider Information | |||||||||
| NPI: | 1083825749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMONS | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | P.T. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 PEARL ST | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803012438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036423825 | ||||||||
| FaxNumber: | 3036421396 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 MAPLETON AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803043979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034410506 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 3690 | CO | Y | Other Service Providers | Specialist |
No ID Information.