Provider Demographics
NPI:1629594767
Name:SIMMONS, SPENCER (DPT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 PINE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6960
Mailing Address - Country:US
Mailing Address - Phone:860-585-5800
Mailing Address - Fax:860-585-5840
Practice Address - Street 1:72 PINE ST UNIT A
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6960
Practice Address - Country:US
Practice Address - Phone:860-585-5800
Practice Address - Fax:860-585-5840
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042161225100000X
CT011639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist