Provider Demographics
NPI:1255585147
Name:SIMMONS, DEBRA FAY (LMP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:FAY
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10211 E MAIN AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-3761
Mailing Address - Country:US
Mailing Address - Phone:509-599-3063
Mailing Address - Fax:
Practice Address - Street 1:122 N ARGONNE RD
Practice Address - Street 2:STE 3
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2550
Practice Address - Country:US
Practice Address - Phone:509-599-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60040583172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist