Provider Demographics
NPI:1679926489
Name:SIMS, GREGORY ALAN
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:SIMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:ALAN
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT/ATC
Mailing Address - Street 1:633 PEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPG
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7443
Mailing Address - Country:US
Mailing Address - Phone:407-415-3572
Mailing Address - Fax:
Practice Address - Street 1:633 PEACHWOOD DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7443
Practice Address - Country:US
Practice Address - Phone:407-415-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer