Provider Demographics
NPI:1346329083
Name:SIMPSON, DOUGLAS B (PT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:B
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:824 W LEWIS ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5561
Mailing Address - Country:US
Mailing Address - Phone:509-544-0265
Mailing Address - Fax:509-544-0304
Practice Address - Street 1:2470 N STOKESBURY PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5035
Practice Address - Country:US
Practice Address - Phone:208-884-8323
Practice Address - Fax:208-885-5708
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1653130Medicare PIN