Basic Information
| Provider Information | |||||||||
| NPI: | 1295744126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MADURA | ||||||||
| OtherFirstName: | PAMELA | ||||||||
| OtherMiddleName: | J. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 31 OLD ROUTE 7 | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068041714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037400020 | ||||||||
| FaxNumber: | 2037750238 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 GERMANTOWN RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068105023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037784773 | ||||||||
| FaxNumber: | 2037784774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 007927 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 080007927 | 01 | CT | ANTHEM BC | OTHER | 004262177 | 01 | CT | MEDICAID | OTHER |