MEDICARE: MS. ALICIA SIMMONDS MS, ATC, PES

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	2255A2300X	Athletic Trainer	LAT-4165	NC
2	2255A2300X	Athletic Trainer	0126003502	VA
3	2255A2300X	Athletic Trainer	RT004004	PA
4	2255A2300X	Athletic Trainer	2571	TN
5	2255A2300X	Athletic Trainer	001523-1	NY

General Provider Information

NPI Number	:	1477621746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICIA SIMMONDS MS, ATC, PES

Provider Business Mailing Address
First Line	:	520 W 2ND ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2644
Country	:	US
Telephone Number	:	716-785-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 W 2ND ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2644
Country	:	US
Telephone Number	:	716-785-5472
Fax Number	:

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

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	08/26/2024

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