Provider Demographics
NPI:1659146710
Name:SIMS, DEANNA PAIGE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:PAIGE
Last Name:SIMS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:PAIGE
Other - Last Name:ROSEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 N BRAND BLVD STE J&K
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3070
Mailing Address - Country:US
Mailing Address - Phone:818-244-0468
Mailing Address - Fax:
Practice Address - Street 1:1111 N BRAND BLVD STE J&K
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3070
Practice Address - Country:US
Practice Address - Phone:818-244-0468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist