Provider Demographics
NPI:1316004252
Name:SIMS, QUENTIN DOUGLAS (PT)
Entity Type:Individual
Prefix:MR
First Name:QUENTIN
Middle Name:DOUGLAS
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 1:2530 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1602
Mailing Address - Country:US
Mailing Address - Phone:805-928-4465
Mailing Address - Fax:805-928-7935
Practice Address - Street 1:2530 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1602
Practice Address - Country:US
Practice Address - Phone:805-928-4465
Practice Address - Fax:805-928-7935
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0145290Medicaid
CAOPT14529OOtherBLUE SHIELD
CAPT0145290Medicaid