Provider Demographics
NPI:1285280545
Name:SIMAC, THOMAS RICHARD
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:SIMAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 CAVE MILL STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6364
Mailing Address - Country:US
Mailing Address - Phone:224-735-6856
Mailing Address - Fax:
Practice Address - Street 1:210 LINDSEY WILSON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1223
Practice Address - Country:US
Practice Address - Phone:224-735-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer