Provider Demographics
NPI:1184285991
Name:SIMMONS, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SIMMONS
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 1:160 JOHN REZZA DR
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02763-4052
Mailing Address - Country:US
Mailing Address - Phone:508-510-1029
Mailing Address - Fax:
Practice Address - Street 1:3975 OLD REDWOOD HWY STE 152
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1719
Practice Address - Country:US
Practice Address - Phone:707-566-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2965732251X0800X
COPTL.0013705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic