Provider Demographics
NPI:1578547410
Name:SIMMONS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:SIMMONS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-633-1345
Mailing Address - Street 1:285 N EL CAMINO REAL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5383
Mailing Address - Country:US
Mailing Address - Phone:760-633-1345
Mailing Address - Fax:760-633-1419
Practice Address - Street 1:285 N EL CAMINO REAL
Practice Address - Street 2:SUITE 202
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5383
Practice Address - Country:US
Practice Address - Phone:760-633-1345
Practice Address - Fax:760-633-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11587261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT11587OtherP.T. STATE LICENSE NUMBER
CAW16400Medicare ID - Type UnspecifiedPROVIDER NUMBER