Provider Demographics
NPI:1376223875
Name:SIMONS, WILLARD NICHOLAS
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:NICHOLAS
Last Name:SIMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 N SHORE RD
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-9227
Mailing Address - Country:US
Mailing Address - Phone:585-610-6996
Mailing Address - Fax:
Practice Address - Street 1:355 N SHORE RD
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-9227
Practice Address - Country:US
Practice Address - Phone:585-610-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant