Provider Demographics
NPI:1710547880
Name:SIMS, BRAM COOPER (DPT)
Entity Type:Individual
Prefix:
First Name:BRAM
Middle Name:COOPER
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 1:6203 SPERRYVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:22713-4150
Mailing Address - Country:US
Mailing Address - Phone:540-718-7931
Mailing Address - Fax:
Practice Address - Street 1:5121 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11324980-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist