Provider Demographics
NPI:1215561071
Name:SIMMONS, NICHOLAS E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:E
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14311 ANITA MARIE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6813
Mailing Address - Country:US
Mailing Address - Phone:512-800-4545
Mailing Address - Fax:
Practice Address - Street 1:8017 MESA DR STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1313
Practice Address - Country:US
Practice Address - Phone:512-791-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1329221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist