Basic Information
| Provider Information | |||||||||
| NPI: | 1154393064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, ATC, CSCS, CWCHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8959 GIOVANNI CT | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488556304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8105882261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10860 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | HARTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483532629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106321000 | ||||||||
| FaxNumber: | 8106321001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 10/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 2601000024 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.