Provider Demographics
NPI:1144607078
Name:SIMMONS, AMY ELIZABETH (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:ELIZABETH
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:321 DORCHESTER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2425
Mailing Address - Country:US
Mailing Address - Phone:410-228-5100
Mailing Address - Fax:410-228-7479
Practice Address - Street 1:321 DORCHESTER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2425
Practice Address - Country:US
Practice Address - Phone:410-228-5100
Practice Address - Fax:410-228-7479
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDA00004482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer