MEDICARE: MS. CYNTHIA MARIA SIMMONS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305004230	VA

General Provider Information

NPI Number	:	1386657708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA MARIA SIMMONS PT

Provider Business Mailing Address
First Line	:	992 SANDOVAL DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-7211
Country	:	US
Telephone Number	:	757-430-0464
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 GENERAL BOOTH BLVD
Second Line	:	STE. 152
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5881
Country	:	US
Telephone Number	:	757-430-8828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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