Provider Demographics
NPI:1760500342
Name:SIMMONS, JAMES MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3851
Mailing Address - Country:US
Mailing Address - Phone:509-469-7474
Mailing Address - Fax:509-469-7575
Practice Address - Street 1:1127 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3851
Practice Address - Country:US
Practice Address - Phone:509-469-7474
Practice Address - Fax:509-469-7575
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8344731Medicaid
WA134660OtherLABOR & INDUSTRIES
WASI3720OtherREGENCE BLUE SHIELD
WA8344731Medicaid