Provider Demographics
NPI:1164401709
Name:SIMMONS, TAMMY MARIE (MHS, PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 S HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9438
Mailing Address - Country:US
Mailing Address - Phone:317-965-3483
Mailing Address - Fax:317-806-7804
Practice Address - Street 1:6239 S EAST ST
Practice Address - Street 2:A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2090
Practice Address - Country:US
Practice Address - Phone:317-791-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002124A2251X0800X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000369371OtherANTHEM BC/BS
IN185500CMedicare ID - Type UnspecifiedPART B