Provider Demographics
NPI:1598214744
Name:SIMMS, IAN (PTA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:SIMMS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 2ND MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8212
Mailing Address - Country:US
Mailing Address - Phone:570-573-9897
Mailing Address - Fax:
Practice Address - Street 1:200 TAYLORSVILLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:PA
Practice Address - Zip Code:17964-9104
Practice Address - Country:US
Practice Address - Phone:866-333-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE010513225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant