Provider Demographics
NPI:1093749681
Name:SIMS, JOHN (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SIMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25200 LA PAZ RD
Mailing Address - Street 2:STE 102
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5134
Mailing Address - Country:US
Mailing Address - Phone:949-770-8767
Mailing Address - Fax:949-770-8767
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:SUITE 400
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-587-1155
Practice Address - Fax:949-465-8159
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ67504Medicare UPIN
CAWPT32642AMedicare ID - Type Unspecified