Basic Information
| Provider Information | |||||||||
| NPI: | 1578547410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIMMONS PHYSICAL THERAPY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 N EL CAMINO REAL | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606331345 | ||||||||
| FaxNumber: | 7606331419 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 N EL CAMINO REAL | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606331345 | ||||||||
| FaxNumber: | 7606331419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 10/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | SIMMONS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7606331345 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | PT11587 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | PT11587 | 01 | CA | P.T. STATE LICENSE NUMBER | OTHER |