Provider Demographics
NPI:1760473813
Name:SIMMONS, BRANDY L (PT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:L
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:L
Other - Last Name:SCHECKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 N BLUFF BLVD
Mailing Address - Street 2:STE 101 PO BOX 337
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-7146
Mailing Address - Country:US
Mailing Address - Phone:563-519-0242
Mailing Address - Fax:563-241-4353
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:PLAZA PHYSICAL THERAPY
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-344-6645
Practice Address - Fax:563-441-7796
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03086225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0289066Medicaid
IA0289066Medicaid
P80277Medicare UPIN