Basic Information
| Provider Information | |||||||||
| NPI: | 1437886876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMMS | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1710 BRUCE AVE UNIT 301 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452232199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025541234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7753 BEECHMONT AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452554203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132322663 | ||||||||
| FaxNumber: | 8598177848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2022 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT020035 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT020035 | 01 | OH | OTPTAT BOARD | OTHER |