Provider Demographics
NPI:1942376769
Name:SIMMONS, GEOFFREY WAYNE (PT)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:WAYNE
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 1:3003 N A ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5304
Mailing Address - Country:US
Mailing Address - Phone:432-618-9952
Mailing Address - Fax:432-618-9953
Practice Address - Street 1:3003 N A ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-5304
Practice Address - Country:US
Practice Address - Phone:432-684-7755
Practice Address - Fax:432-684-7962
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist