Provider Demographics
NPI:1073740197
Name:ANDERSON, PATRICIA SIMMONS (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SIMMONS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2113
Mailing Address - Country:US
Mailing Address - Phone:847-328-2405
Mailing Address - Fax:847-864-7806
Practice Address - Street 1:1024 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2113
Practice Address - Country:US
Practice Address - Phone:847-328-2405
Practice Address - Fax:847-864-7806
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.002344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist