Provider Demographics
NPI:1669009049
Name:SIMS, KELLER DAVIS (DPT)
Entity Type:Individual
Prefix:
First Name:KELLER
Middle Name:DAVIS
Last Name:SIMS
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 1:2403 W HUDSON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-2079
Mailing Address - Country:US
Mailing Address - Phone:479-340-1100
Mailing Address - Fax:
Practice Address - Street 1:2403 W HUDSON RD STE
Practice Address - Street 2:STE 1
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-340-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist