Provider Demographics
NPI:1811031677
Name:EDWARD SIMMONS MASSAGE THERAPISTS LLC
Entity Type:Organization
Organization Name:EDWARD SIMMONS MASSAGE THERAPISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CORNELIUS
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:313-273-8510
Mailing Address - Street 1:15756 FORRER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-2333
Mailing Address - Country:US
Mailing Address - Phone:313-273-8510
Mailing Address - Fax:
Practice Address - Street 1:15756 FORRER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2333
Practice Address - Country:US
Practice Address - Phone:313-273-8510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty