Provider Demographics
NPI:1477527612
Name:SIMMERMAN, SUSANNE MARIE (PT, SCD, OCS)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:MARIE
Last Name:SIMMERMAN
Suffix:
Gender:F
Credentials:PT, SCD, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7925
Mailing Address - Country:US
Mailing Address - Phone:817-641-8617
Mailing Address - Fax:817-641-8620
Practice Address - Street 1:1014 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7925
Practice Address - Country:US
Practice Address - Phone:817-641-8617
Practice Address - Fax:817-645-8620
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137901225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650003053OtherRAILROAD PIN
TX80236TOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX140989801Medicaid
TX80236TOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX83451EMedicare PIN