Provider Demographics
NPI:1154393064
Name:SIMMONS, ERIC JAMES (MS, ATC, CSCS, CWCHP)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MS, ATC, CSCS, CWCHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8959 GIOVANNI CT
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-6304
Mailing Address - Country:US
Mailing Address - Phone:810-588-2261
Mailing Address - Fax:
Practice Address - Street 1:10860 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2629
Practice Address - Country:US
Practice Address - Phone:810-632-1000
Practice Address - Fax:810-632-1001
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010000242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer