Provider Demographics
NPI:1568861805
Name:SIMMONS, JAMES MICHAEL
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:SIMMONS
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 1:12770 SOUTH FWY
Mailing Address - Street 2:SUITE 144
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8447
Mailing Address - Country:US
Mailing Address - Phone:817-426-4401
Mailing Address - Fax:817-426-4410
Practice Address - Street 1:12770 SOUTH FWY
Practice Address - Street 2:SUITE 144
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8447
Practice Address - Country:US
Practice Address - Phone:817-426-4401
Practice Address - Fax:817-426-4410
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1247131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist