Provider Demographics
NPI:1770571788
Name:SIMMONS, MICHAEL (LMT, CLT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19971 BACK NINE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4706
Mailing Address - Country:US
Mailing Address - Phone:561-306-6618
Mailing Address - Fax:
Practice Address - Street 1:19971 BACK NINE DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4706
Practice Address - Country:US
Practice Address - Phone:561-306-6618
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37889225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist